How We Approach Combination Antifungal Therapy for Invasive Aspergillosis and Mucormycosis in Transplant Recipients

Transplantation. 2018 Nov;102(11):1815-1823. doi: 10.1097/TP.0000000000002353.

Abstract

Invasive aspergillosis and mucormycosis are life-threatening infections in solid organ and hematopoietic cell transplant recipients. Despite medical advancements in the care of these patients and the availability of new mold-active drugs, the outcomes remain suboptimal. Therefore, there has been increased interest in the use of combination antifungal therapy, in hopes that leveraging the possible in vitro synergy of these agents will improve the prognosis of invasive mold disease. However, there has been a large disconnect between the results of experimental and clinical investigations, as clinical studies have not unequivocally demonstrated the superiority of combination therapy over monotherapy. This is particularly true for mucormycosis, where the rarity of the condition has made it nearly impossible to prospectively study novel therapeutic strategies. We review the current standard of antifungal therapy and the preclinical and clinical data addressing the merit of combination therapy, and we provide guidance to optimize the management of these mycoses.

Publication types

  • Review

MeSH terms

  • Animals
  • Antifungal Agents / adverse effects
  • Antifungal Agents / therapeutic use*
  • Aspergillosis / diagnosis
  • Aspergillosis / drug therapy*
  • Aspergillosis / immunology
  • Aspergillosis / microbiology
  • Drug Therapy, Combination
  • Humans
  • Immunocompromised Host*
  • Immunosuppressive Agents / adverse effects*
  • Invasive Fungal Infections / diagnosis
  • Invasive Fungal Infections / drug therapy*
  • Invasive Fungal Infections / immunology
  • Invasive Fungal Infections / microbiology
  • Mucormycosis / diagnosis
  • Mucormycosis / drug therapy*
  • Mucormycosis / immunology
  • Mucormycosis / microbiology
  • Opportunistic Infections / diagnosis
  • Opportunistic Infections / drug therapy*
  • Opportunistic Infections / immunology
  • Opportunistic Infections / microbiology
  • Organ Transplantation / adverse effects*
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Immunosuppressive Agents