Treatment options of invasive fungal infections in adults.
A panel of infectious disease specialists, clinical microbiologists and hospital epidemiologists of the five Swiss university hospitals reviewed the current literature on the treatment of invasive fungal infections in adults and formulated guidelines for the management of patients in Switzerland. For empirical therapy of Candida bloodstream infection, fluconazole is the drug of choice in non-neutropenic patients with no severe sepsis or septic shock or recent exposure to azoles. Amphotericin B deoxycholate or caspofungin would be the treatment option for patients with previous azole exposure. In neutropenic patients, empirical therapy with amphotericin B deoxycholate is considered first choice. In patients with severe sepsis and septic shock, caspofungin is the drug of first choice. For therapy of microbiologically-documented Candida infection, fluconazole is the drug of choice for infections due to C. albicans, C. tropicalis or C. parapsilosis. When infections are caused by C. glabrata or by C. krusei, caspofungin or amphotericin B deoxycholate are first line therapies. Treatment guidelines for invasive aspergillosis (IA) were stratified into primary therapy, salvage therapy and combination therapy in critically ill patients. Voriconazole is recommended for primary (ie upfront) therapy. Caspofungin, voriconazole (if not used for primary therapy) or liposomal amphotericin B are recommended for salvage therapy for refractory disease. Combination therapy with caspofungin plus voriconazole or liposomal amphotericin B should be considered in critically ill patients. Amphotericin B deoxycholate is recommended as initial therapy for the empirical therapy in patients with neutropenia and persistent fever with close monitoring of adverse events.
Flückiger
Ursula
U
Division of Infectious Diseases & Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland. uflueckiger@uhbs.ch
Marchetti
Oscar
O
Bille
Jacques
J
Eggimann
Philippe
P
Zimmerli
Stefan
S
Imhof
Alexander
A
Garbino
Jorge
J
Ruef
Christian
C
Pittet
Didier
D
Täuber
Martin
M
Glauser
Michel
M
Calandra
Thierry
T
D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000453:epidemiology; D001393:Azoles / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D054714:Echinocandins; D005656:Fungal Proteins / Q000627:therapeutic use; D006801:Humans; D010456:Peptides, Cyclic / Q000627:therapeutic use; D011090:Polyenes / Q000627:therapeutic use; D013557:Switzerland / Q000453:epidemiology
D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins; D005656:Fungal Proteins; D010456:Peptides, Cyclic; D011090:Polyenes; C007572:echinocandin B