Summary: future directions in antifungal therapy.
The development of strategies for the prevention and treatment of invasive fungal infection is reviewed. The optimal deployment of antifungal agents is impeded by delays in diagnosis, which reflect the need for tissue samples for histopathology and/or the slow growth of organisms in culture for identification. Further, the lack of rapid and standardized methods for antimicrobial susceptibility testing has been identified as a major hurdle to optimal management. It is likely that combinations of antifungal agents will be needed to accelerate the clinical response to therapy (i.e., killing of fungus in tissues more rapidly). Such combinations may have the capacity to reduce toxicity while providing either true additive or synergistic activities or improved pharmacokinetics to "target" infection in multiple sites. Preclinical studies and clinical trials will begin to identify candidate therapies for invasive fungal infections in transplantation.
Fishman
J A
JA
Harvard Medical School, Transplant Infectious Diseases and Compromised Host Program, Infectious Disease Division and Transplant Unit, Massachusetts General Hospital, Boston, Massachusetts, USA. jfishman@partners.org
D000935:Antifungal Agents / Q000191:economics / Q000592:standards / Q000627:therapeutic use*; D015507:Drugs, Investigational / Q000145:classification / Q000627:therapeutic use; D005544:Forecasting; D005658:Fungi / Q000187:drug effects; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D009181:Mycoses / Q000188:drug therapy* / Q000276:immunology
D000935:Antifungal Agents; D015507:Drugs, Investigational