Recent advances in the treatment of life-threatening, invasive fungal infections.
BACKGROUND
Invasive fungal infections (IFIs) pose significant morbidity and are often life-threatening to many high-risk patients. Timely diagnosis and treatment of these infections with optimal therapy is imperative.


METHODS
Advances have been made in diagnostic biomarkers such as peptide nucleic acid fluorescent in situ hybridization, β-D-glucan and galactomannan, although more research is needed in this area to assist with both diagnosis and monitoring for improvement of IFI management. Novel antifungal agents (azole antifungals and echinocandins) are being investigated that have activity against Candida spp. and Aspergillus spp. Optimizing the pharmacodynamics (PD) of our current antifungal therapies through such strategies as continuous infusion of amphotericin B and dose escalation of echinocandins and liposomal formulations of amphotericin B have also been investigated with mixed results. Therapeutic drug monitoring (TDM) shows promise as evident from data with such agents as flucytosine, itraconazole, voriconazole and posaconazole.


CONCLUSIONS
The goal for the future of biomarkers in IFIs will be to have excellent sensitivity and specificity to ideally identify a particular fungus causing the infection or eliminate its existence to prevent unnecessary costs, resistance and antifungal usage. In addition, further developments of new antifungals are needed and judicious use of the current regimens needs to be optimized through antifungal PD properties and TDM.
Duke University School of Medicine, Duke University Medical Center, Division of Infectious Diseases , Box 102359, Durham, NC 27710 , USA +1 919 681 6793 ; +1 919 681 6793 ; richard.drew@duke.edu.
Richard H
RH
Drew
Mary L
ML
Townsend
Melanie W
MW
Pound
Steven W
SW
Johnson
John R
JR
Perfect
D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D006801:Humans; D009181:Mycoses / Q000188:drug therapy*
D000935:Antifungal Agents