[Advances in the diagnosis and treatment of yeast infections: role of the new antifungal agents].
Invasive candidiasis has become a public health problem due to the high associated rates of morbidity and mortality. As in other systemic infections, accurate and early diagnosis is essential. Despite its limited sensitivity (50%), blood culture continues to be the most effective technique for the diagnosis of candidemia. New culture-independent techniques have been marketed with the aim of improving diagnostic yield. Among these techniques, the most notable are (1-3)-beta-D-glucan and anti-germ-tube antibody detection. However, the best option to optimize the diagnosis of invasive candidiasis seems to be the combination of two techniques that detect antigen, antibodies, (1-3)-beta-D-glucan or DNA. Fluconazole, and sometimes amphotericin B, remain the antifungal agents of choice for the treatment of candidiasis. In the last few years, new antifungal agents have been introduced with the aim of improving the prognosis of some clinical presentations of this disease. The echinocandins and second-generation triazoles show greater antifungal activity than fluconazole. Moreover, clinical trials of candidiasis in different localizations have shown that these drugs have excellent efficacy and safety profiles. The potential for drug interactions with some of these antifungal agents is considerable. The contribution of the new antifungal drugs in the treatment of candidiasis should be defined in the near future.
Pemán
Javier
J
Servicio de Microbiología, Hospital Universitario La Fe, Valencia, España. peman_jav@gva.es
Almirante
Benito
B
D000666:Amphotericin B / Q000627:therapeutic use; D000908:Antibodies, Fungal / Q000097:blood; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000935:Antifungal Agents / Q000627:therapeutic use*; D000946:Antigens, Fungal / Q000097:blood; D002175:Candida / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D004271:DNA, Fungal / Q000097:blood; D004347:Drug Interactions; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use; D016469:Fungemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D009172:Mycology / Q000379:methods; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy; D014230:Triazoles / Q000493:pharmacokinetics / Q000627:therapeutic use; D015003:Yeasts
D000908:Antibodies, Fungal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000935:Antifungal Agents; D000946:Antigens, Fungal; D004271:DNA, Fungal; D054714:Echinocandins; D014230:Triazoles; D000666:Amphotericin B; C512268:efungumab