title: Treatment of severe Candida infections in high-risk patients in Germany: consensus formed by a panel of interdisciplinary investigators.
abstract: Now that modern medicine can provide increasing chances of cure to patients with formerly incurable disorders, therapy-related complications play the key role in outcome. Thus, among opportunistic infections, severe candidiasis remains a challenge. A multidisciplinary panel of 20 investigators was formed to find a consensus on antifungal strategies for various underlying conditions in neutropenic and non-neutropenic patients. To record their preferences, the investigators used an anonymous voting system. Among antifungal agents, fluconazole emerged as the major alternative to the classic amphotericin B, being therapeutically at least equivalent but clearly less toxic. Factors that restrict the use of fluconazole include pretreatment with azoles, involvement of resistant species like Candida krusei, and an inability to exclude aspergillosis. Flucytosine can be reasonably combined with both amphotericin B and fluconazole. Within the limited antifungal armamentarium, amphotericin B lipid formulations and itraconazole also appear useful and require further investigation. The general consensus of the group is that antifungal agents should be administered at sufficient dosages, rather early, and often empirically.
authors.affiliation: Department of Medicine, Hematology/Oncology, University of Münster, Albert-Schweitzer-Strasse 33, Germany. buechnr@uni-muenster.de
authors.forename: T
authors.initials: T
authors.lastname: Büchner
authors.forename: W
authors.initials: W
authors.lastname: Fegeler
authors.forename: H
authors.initials: H
authors.lastname: Bernhardt
authors.forename: N
authors.initials: N
authors.lastname: Brockmeyer
authors.forename: K-H
authors.initials: KH
authors.lastname: Duswald
authors.forename: M
authors.initials: M
authors.lastname: Herrmann
authors.forename: D
authors.initials: D
authors.lastname: Heuser
authors.forename: U
authors.initials: U
authors.lastname: Jehn
authors.forename: G
authors.initials: G
authors.lastname: Just-Nübling
authors.forename: M
authors.initials: M
authors.lastname: Karthaus
authors.forename: G
authors.initials: G
authors.lastname: Maschmeyer
authors.forename: F-M
authors.initials: FM
authors.lastname: Müller
authors.forename: J
authors.initials: J
authors.lastname: Müller
authors.forename: J
authors.initials: J
authors.lastname: Ritter
authors.forename: N
authors.initials: N
authors.lastname: Roos
authors.forename: M
authors.initials: M
authors.lastname: Ruhnke
authors.forename: A
authors.initials: A
authors.lastname: Schmalreck
authors.forename: R
authors.initials: R
authors.lastname: Schwarze
authors.forename: G
authors.initials: G
authors.lastname: Schwesinger
authors.forename: G
authors.initials: G
authors.lastname: Silling
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D002908:Chronic Disease / Q000188:drug therapy; D003115:Colony-Stimulating Factors / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016469:Fungemia / Q000188:drug therapy / Q000382:microbiology; D005858:Germany; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy; D016533:Mycological Typing Techniques; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D003115:Colony-Stimulating Factors