Document Detail


Combination treatment of invasive fungal infections.
MedLine Citation:
PMID:  15653825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The persistence of high morbidity and mortality from systemic fungal infections despite the availability of novel antifungals points to the need for effective treatment strategies. Treatment of invasive fungal infections is often hampered by drug toxicity, tolerability, and specificity issues, and added complications often arise due to the lack of diagnostic tests and to treatment complexities. Combination therapy has been suggested as a possible approach to improve treatment outcome. In this article, we undertake a historical review of studies of combination therapy and also focus on recent studies involving newly approved antifungal agents. The limitations surrounding antifungal combinations include nonuniform interpretation criteria, inability to predict the likelihood of clinical success, strain variability, and variations in pharmacodynamic/pharmacokinetic properties of antifungals used in combination. The issue of antagonism between polyenes and azoles is beginning to be addressed, but data regarding other drug combinations are not adequate for us to draw definite conclusions. However, recent data have identified potentially useful combinations. Standardization of assay methods and adoption of common interpretive criteria are essential to avoid discrepancies between different in vitro studies. Larger clinical trials are needed to assess whether combination therapy improves survival and treatment outcome in the most seriously debilitated patients afflicted with life-threatening fungal infections.
Authors:
Pranab K Mukherjee; Daniel J Sheehan; Christopher A Hitchcock; Mahmoud A Ghannoum
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical microbiology reviews     Volume:  18     ISSN:  0893-8512     ISO Abbreviation:  Clin. Microbiol. Rev.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-01-17     Completed Date:  2005-03-15     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  8807282     Medline TA:  Clin Microbiol Rev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  163-94     Citation Subset:  IM    
Affiliation:
Center for Medical Mycology, Department of Dermatology, Case Western Reserve University and University Hospitals of Cleveland, 11100 Euclid Ave., LKS-5028, Cleveland, OH 44106-5028, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Antifungal Agents / pharmacology,  therapeutic use*
Drug Interactions
Drug Resistance, Fungal
Drug Therapy, Combination
Fungi / classification,  drug effects*
Guinea Pigs
Humans
Mice
Microbial Sensitivity Tests
Mycoses / drug therapy*,  microbiology
Chemical
Reg. No./Substance:
0/Antifungal Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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