Candidal Sepsis and Meningitis in a Very-Low-Birth-Weight Infant Successfully Treated with Fluconazole and Flucytosine

Marr, Bonnie; Groß, Steven; Cunningham, Coleen K.; Weiner, Leonard B.

doi:10.1093/clinids/19.4.795

Cited by 19 publications

(9 citation statements)

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“…Although there was no difference between regimens with respect to cure rates, patients receiving combination therapy showed earlier elimination of fungal pathogens than did patients receiving monotherapy with FLU (median elimination time, 8.5 days in the FLU arm and 5.5 days in the AmB-plus-5FC group). Additional studies in support of AmB-plus-5FC and FLU-plus-5FC combinations include those performed by Levine et al (122), Smego et al (206), and Marr et al (142), indicating the clinical usefulness of these combinations.…”

Section: Dual Combinations In the Practice Guidelines For Candidiasismentioning

confidence: 97%

Combination Treatment of Invasive Fungal Infections

et al. 2005

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The persistence of high morbidity and mortality from systemic fungal infections despite the availability of novel antifungals points to the need for effective treatment strategies. Treatment of invasive fungal infections is often hampered by drug toxicity, tolerability, and specificity issues, and added complications often arise due to the lack of diagnostic tests and to treatment complexities. Combination therapy has been suggested as a possible approach to improve treatment outcome. In this article, we undertake a historical review of studies of combination therapy and also focus on recent studies involving newly approved antifungal agents. The limitations surrounding antifungal combinations include nonuniform interpretation criteria, inability to predict the likelihood of clinical success, strain variability, and variations in pharmacodynamic/pharmacokinetic properties of antifungals used in combination. The issue of antagonism between polyenes and azoles is beginning to be addressed, but data regarding other drug combinations are not adequate for us to draw definite conclusions. However, recent data have identified potentially useful combinations. Standardization of assay methods and adoption of common interpretive criteria are essential to avoid discrepancies between different in vitro studies. Larger clinical trials are needed to assess whether combination therapy improves survival and treatment outcome in the most seriously debilitated patients afflicted with life-threatening fungal infections

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Section: Dual Combinations In the Practice Guidelines For Candidiasismentioning

confidence: 97%

Combination Treatment of Invasive Fungal Infections

et al. 2005

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“…However, the only data available on the clinical use of liposomal amphotericin B are for newborn infants (Scarcella et al , 1998; Tweddle et al , 1998). The combination of fluconazole with 5‐flucytosine for candidal meningitis has been reported in one case (Marr et al , 1994); however, given reports of refractory and relapsed disease in patients treated with fluconazole, the combination of fluconazole and 5‐flucytosine should be reserved for patients who cannot tolerate amphotericin B or have previously had severe toxic reactions to amphotericin B therapy.…”

Section: Opportunistic Infectionsmentioning

confidence: 99%

Management of intracranial fungal infections in patients with haematological malignancies

Mattiuzzi

Giles

2005

Br J Haematol

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SummaryThe incidence of, and mortality associated with, invasive fungal infections remains far higher than hoped. As a consequence of the overall increase in the incidence of such infections over time, the incidence of central nervous system (CNS) fungal infections is also increasing and, despite improvements in diagnostic techniques and the introduction of novel antifungal agents, therapy for CNS infections is still associated with discouragingly poor results. In patients with haematological malignancies, opportunistic infections with Candida or Aspergillus remain the most common infections affecting the CNS; however, opportunistic infections with less well-known fungi are becoming more common and must be considered in the differential diagnosis. New techniques for the early diagnosis of invasive fungal infections are emerging. Pharmacologic options for treating invasive fungal infections have also improved during the past few years, with new drugs becoming available that have broader antifungal spectra and better safety profiles. Other novel treatment approaches, such as combination therapy, are also being explored. Early investigations have produced encouraging results; however, large, prospective studies involving many patients are necessary to validate the widespread use of these approaches. This review analyses the existing guidelines for treatment of CNS fungal infections and the literature available on the use of new drugs to generate sets of recommendations for treatment of these life-threatening infections in patients with haematological malignancies.

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“…2,23,24 Other potential regimens include intravenous lipid formulations of amphotericin B, intrathecal amphotericin B, or intravenous fluconazole. 7,25,26 Lipid formulations of amphotericin B have been used successfully in Candida meningitis among neonates. 26 Intrathecal amphotericin B is usually reserved for severe cases because of its potential to cause chemical arachnoiditis or ventriculitis.…”

Section: Discussionmentioning

confidence: 99%