Therapie schwerer Pilzinfektionen

Abstract

Severe fungal infections increase in numbers in the Western world. This is due to more intensive therapies against cancers leading to severe and prolonged immunosuppression. For many years treatment of severe fungal infections had to be done solely with amphothericin B desoxycholate and 5-fluorocytosine. With the advent of triazoles such as fluconazole, lipid formulations of amphotericin B and the development of echinocandines such as caspofungin also severe candidiasis and invasive aspergillosis has become treatable. In particular, caspofungin for invasive candidiasis and voriconazole for invasive aspergillosis seem at least equivalent to amphotericin B. A clear advantage is the advent of lipid formulations of amphotericin B. This regards especially side effects which are reduced with these newer formulations, i.e. nephrotoxicity. Due to the fact that prospective trials are difficult to conduct because patient populations may vary considerably (especially the underlying disease) many comparisons were not yet performed. Nevertheless, promising results indicate that certain combinations of antifungals may enhance prognosis of refractory fungal infections with a so far very serious prognosis.

Conazoles

“…In immunosuppressed patients (organ transplantation and HIV-infected people) severe mucosal candidiasis can be treated very well with itraconazole with a response rate of 90%, and similar response rates are obtained with fluconazole [ 94 ]. In Candida esophagitis fluconazole and itraconazole both are indicated [ 94 ].…”

“…In immunosuppressed patients (organ transplantation and HIV-infected people) severe mucosal candidiasis can be treated very well with itraconazole with a response rate of 90%, and similar response rates are obtained with fluconazole [ 94 ]. In Candida esophagitis fluconazole and itraconazole both are indicated [ 94 ]. Relapsed vulvovaginal candidiass in patients with an underlying disease like diabetes mellitus can be treated with fluconazole 150 mg pro week or with itraconazole 100 mg daily [ 94 ].…”

“…In Candida esophagitis fluconazole and itraconazole both are indicated [ 94 ]. Relapsed vulvovaginal candidiass in patients with an underlying disease like diabetes mellitus can be treated with fluconazole 150 mg pro week or with itraconazole 100 mg daily [ 94 ].…”

Successful Management of Invasive Pulmonary Nocardiosis and Aspergillosis in a Patient with T-Cell Lymphoma: A Case Report

“…Fortunately, the past few years have brought remarkable advancements in antifungal pharmacotherapy as several new antifungals have been introduced (Battegay and Fluckiger, 2003). With the advent of the new triazoles e.g.…”

“…The lipid formulations of amphoteircin-B have shown a clear advantage in reducing the side effects e.g. nephrotoxicity of amphotericin-B (Battegay and Fluckiger, 2003). Caspofungin has been shown to be as effective as and generally better tolerated than liposomal amphotericin B when given as empirical antifungal therapy in patients with prolonged neutropenia having persistent pyrexia (Walsh et al 2004).…”