Filamentous fungal infections and the role of amphotericin B

Denning D.W.

Author address: 

NULL

Abstract: 

In the neutropenic setting, filamentous fungal infections are usually caused by Aspergillus species, A. fumigatus being most common. Less common infections include caused by several Zygomycetes species, Fusarium spp, Scedosporium spp. and even rarer moulds. Voriconazole is the treatment of choice for invasive aspergillosis and S. apiospermum infection, and may be effective for Fusarium spp., but is ineffective for any infections caused by the Zygomycetes. Micafungin and other echinocandins are only effective for Candida and Aspergillus infections, and less effective for invasive aspergillosis during profound neutropenia, than in non-neutropenic patients. Unfortunately azole resistance in A. fumigatus is increasing (in Europe), particularly itraconazole resistance, but also cross resistance to voriconazole and posaconazole. A. terreus and A. nidulans are resistant to amphotericin B. The role of amphotericin B (including the less nephrotoxic AmBisome (liposomal amphotericin B)) is: "¢ Zygomycosis "¢ Azole resistant aspergillosis "¢ Azole breakthrough infections, including prophylaxis failure, if adequate bioavailaity has been demonstrated with itraconazole "¢ Major drug interactions, such as concurrent administration of rifampicin, carbamezepine, phenobarbitone and other CYP 51A inducing agents "¢ Renal failure (if IV voriconazole is required) "¢ Invasive aspergillosis failing therapy with voriconazole, posaconazole or echinocandin therapy "¢ Some very rare fungal infections, unresponsive to other therapy "¢ Amphotericin B still has an important role to play in the treatment of invasive fungal infecton, even if diminished compared with 10 years ago
2009

abstract No: 

SS-05-2

Full conference title: 

17th International Society for Human and Animal Mycology
    • ISHAM 17th (2009)