Decision making in antifungal monotherapy versus combination therapy.
The availability of new antifungal agents with novel mechanisms of action and improved tolerability has widened the possibilities for combination therapy for difficult-to-treat opportunistic mycoses. However, empiricism largely governs this therapy, especially in patients with invasive mould infections for whom there is a dire need to improve outcomes. Because of difficulties associated with the design and conduct of clinical trials of combination therapy for opportunistic mycoses, most studies are still performed in the laboratory or in animal models. Methods to assess combined antifungal effects in vitro and in animals are poorly standardized, and little evidence suggests that the data generated from these studies are relevant to treating patients. Even without solid evidence to support routine combination therapy, certain principles can guide its use in select patients.
Lewis
Russell E
RE
Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, Texas 77030, USA. rlewis@uh.edu
D000935:Antifungal Agents / Q000008:administration & dosage*; D001228:Aspergillosis / Q000188:drug therapy / Q000473:pathology; D002177:Candidiasis / Q000188:drug therapy / Q000473:pathology; D003657:Decision Making; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D016469:Fungemia / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000473:pathology; D016032:Randomized Controlled Trials as Topic
D000935:Antifungal Agents