Preemptive antifungal therapy: still a way to go

Maertens, Johan; Deeren, Dries; Dierickx, Daan; Theunissen, Koen

doi:10.1097/qco.0b013e3280106854

Cited by 40 publications

(20 citation statements)

References 42 publications

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“…Several studies have also indicated lower GM levels in patients undergoing antifungal treatment, which is an important issue in view of the increasing number of patients who receive antifungal prophylactic or preemptive treatment (9,11). Our findings with IPA patients who were treated with caspofungin indicate a potential interaction of echinocandins with the GM and the BG test results.…”

Section: Discussionsupporting

confidence: 47%

Contribution of the (1→3)-β- d -Glucan Assay for Diagnosis of Invasive Fungal Infections

et al. 2008

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Diagnosis of invasive fungal infection (IFI) remains, and in all who had P. jiroveci pneumonias (100%), and the false-positive rate varied depending on the controls used. It allowed a higher rate of detection among IPA patients compared to the galactomannan enzyme-linked immunosorbent assay (ELISA) (48 versus 39 patients, respectively) and among candidemia patients compared to the mannan ELISA (20 versus 11 patients, respectively). This assay therefore appears to be useful in the diagnosis of IFI, particularly for serum analysis of pneumocystosis pneumonia patients, but further studies are needed to evaluate false-positive rates and its future role in IFI diagnosis.

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Section: Discussionsupporting

confidence: 47%

Contribution of the (1→3)-β- d -Glucan Assay for Diagnosis of Invasive Fungal Infections

et al. 2008

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“…Also, a highly suggestive CT-scan (eg, halo sign during neutropenia) and consecutive negative GM/β-D-glucan detection should trigger an aggressive diagnostic exploration for infection caused by Zygomycetes (Fig. 1) [38,39].…”

Section: Preemptive Antifungal Therapy In Hematology: the Jury Is Stimentioning

confidence: 99%

Early diagnosis and preemptive therapy of pulmonary mold infections in high-risk patients

Maertens¹,

Huysmans²,

Theunissen³

2008

Curr Infect Dis Rep

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The management of pulmonary mold infections in at-risk patients is hampered by the difficulty in diagnosing these infections. Therefore, most practitioners rely on universal prophylaxis and on the early empirical use of antifungals, especially in neutropenic cancer patients and stem cell transplant recipients. However, a strategy of preemptive or diagnostic-driven antifungal therapy is being explored based on advances in imaging techniques and in fungal antigen detection methods. This article highlights the controversies surrounding the prevention and the early treatment of invasive mold infections in high-risk patients.

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“…Conversely, a positive test would trigger an aggressive search of IA, and treatment would be instituted at an early stage of disease [22,26]. It is imperative to better identify the patient at high risk for IA and the periods of high risk, which would improve the predictive value of diagnostic testing and potentially limit overtreatment with antifungal therapy.…”

Section: Preemptive Targeted Therapymentioning

confidence: 99%

Prevention of invasive aspergillosis in high-risk patients: Universal versus preemptive, targeted treatment

Baddley

Apewokin²

2008

Curr Fungal Infect Rep

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Invasive aspergillosis (IA) is associated with increased morbidity and mortality, and there is a need for better preventative and therapeutic approaches. Successful treatment of documented IA remains difficult, often because of the inability to detect disease at an early stage. An important, recent advance in the management of aspergillosis is the availability of the newer broad-spectrum azoles, voriconazole and posaconazole, which have good activity against Aspergillus spp. In addition, newer diagnostic modalities including Aspergillus galactomannan, β-glucan, and polymerase chain reaction are more readily available. These diagnostic and treatment options have made new strategies possible for the management of IA. Prophylaxis and empirical therapy for high-risk patients have been popular for decades, and now a preemptive, targeted approach to IA management has become more attractive. This article reviews strategies for the prevention and management of IA and compares and contrasts universal prophylaxis to the preemptive, targeted approach for IA in high-risk patients.

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Preemptive antifungal therapy: still a way to go

Abstract: The review will consider these recent developments with the purpose of introducing the concept of preemptive antifungal therapy.

Cited by 40 publications

References 42 publications

Contribution of the (1→3)-β- d -Glucan Assay for Diagnosis of Invasive Fungal Infections

Contribution of the (1→3)-β- d -Glucan Assay for Diagnosis of Invasive Fungal Infections

Early diagnosis and preemptive therapy of pulmonary mold infections in high-risk patients

Prevention of invasive aspergillosis in high-risk patients: Universal versus preemptive, targeted treatment

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