Antifungal Therapy for Invasive Fungal Infections

Recently, despite the application of surgery and antifungal therapy, mortality rate of invasive fungal infections due to opportunistic fungi such as Candida and Aspergillus species has dramatically increased specially in immunocompromised host. The status of the immune system plays a key role in controlling the disease, yet antifungal therapy is of great benefit in saving involved patients. Today some efficient antifungal agents are available which are very expensive compared to amphotericin B deoxycholate. The empiric treatment of Candida bloodstream infections is fluconazole therapy which is the best choice for neutropenic patients with and without septic shock. However, amphotericin B deoxycholate and caspofungin therapy are the optional treatments for patients who previously used azole agents. These drugs are considered as the first choice of treatment in patients with neutropenia. Fluconazole therapy is recommended for fungal infections due to C. albicans, C. tropicalis and C. parapsilosis and amphotericin B deoxycholate or caspofungin are applied for C. glabrata and C. krusei. Primary teherapy for invasive aspergillosis includes combination therapy in critically ill patients. Voriconazole and caspofungin (if not used as primary treatment) and liposomal amphotericin B are recommended in patients resistant to conventional treatments. Moreover, combination therapy with caspofungin with voriconazole and liposomal amphotericin B should be considered in severely ill patients. In clinical decision making clinicians should consider the results of different studies and also the cost of treatment.