Overview of guidelines

Ref ID: 19464

Author:

C. Viscoli

Author address:

University of Genova, Italy

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Several guidelines (maybe too many) are available for the manage-
ment of Invasive Fungal Diseases (IFD), coming from different coun-
tries and from different groups of investigators and dealing with different pathogens and with different purposes (diagnosis, prophy-
laxis, treatment).
For Invasive candidiasis (IC), there is general agreement that the
echinocandins have become the cornerstone of therapy, with a vari-
able space left for fluconazole. Which echinocandin should be pre-
ferred remains controversial. The level of agreement (and the
strength of recommendation, as a consequence) is lower for deep-
seated infections and for IC in neutropenic patients. Empirical ther-
apy is not recommended and prophylaxis seems to have a small role,
if any. The recent European guidelines (both ECIL and ESCMID) also
dealt with diagnosis and concluded variably, but in general posi-
tively, for the use of antigen-detection tests for driving therapy. We
are all still waiting for the ’Big Brother’, i.e. biomolecular tests. The
central venous catheter should be removed, whenever possible,
although controversy exists about optimal time for removal.
For aspergillosis, voriconazole and liposomal AmB remain first
choice for primary therapy, waiting for news about combination
therapy and new drugs (isavuconazole) or new formulations (i.v. po-
saconazole). The ECIL guidelines give no recommendations about
fever or diagnostic-driven therapy, just recognizing that the latter is
safe and feasible. In my opinion, these two interventional approaches
should not be necessarily considered as mutually exclusive, but can
live together, with the only difference that empirical therapy can be
stopped very early if the diagnostic work-up comes back negative. In
addition, we should not forget that in some countries diagnostic facil-
ities are not universally available. The important thing about the
diagnostic-driven approach is to realize that the clinical syndrome of
IFD can now be recognized and diagnosed by appropriate clinical,
instrumental (waiting for TC-PET) and microbiological tools.
For mucormycosis, a lipid formulation of AmB with or without po-
saconazole (or with posaconazole in maintenance therapy) is first
choice, but in this case the pivotal and probably decisive role is
played by (repeated?) surgical interventions.
In conclusion, when writing guidelines we should not forget that
we live in a big world and that what is easily available for us, could
not be available in other parts of the world. In addition, guidelines
are useful, but don’t forget to switch-on the brain.

Abstract Number: w13.1

Conference Year: 2013

Link to conference website: NULL

New link: NULL

Conference abstracts, posters & presentations

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