Azole-resistant Aspergillus and Echinocandin-resistant Candida – What are the treatment options?

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Azole-resistant Aspergillus and Echinocandin-resistant Candida - What are the treatment options?

Curr Fungal Infect Rep. 2020 Jun;14(2):141-152

Authors: Novak AR, Bradley ME, Kiser TH, Mueller SW

Abstract
Purpose of Review: This review summarizes current treatment options for echinocandin-resistant Candida spp. (ERC) and azole-resistant Aspergillus fumigatus (ARAF), emphasizing recent in vitro/in vivo data, clinical reports, and consensus statements.
Recent Findings: Advances in ERC and ARAF treatment are limited to specific antifungal combinations and dose optimization but remain reliant on amphotericin products. Although novel antifungals may provide breakthroughs in the treatment of resistant fungi, these agents are not yet available. Early identification and appropriate treatment remain a paramount, albeit elusive, task.
Summary: When either ERC or ARAF are suspected or proven, amphotericin products remain the cornerstone of initial therapy. For ERC, azoles are de-escalation options for susceptible isolates in stable patients to avoid amphotericin toxicities. Although combination echinocandin with high-dose salvage posaconazole or isavuconazole may be attempted in ARAF, it requires careful consideration following patient stabilization. Future research defining optimal therapies and early identification of ERC and ARAF is of extreme importance.

PMID: 32699568 [PubMed]