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Combination Therapy for Invasive Fungal Infections

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Abstract

Purpose of the Review

The purpose of this review is to summarize and evaluate relevant literature on combination antifungal therapy for invasive fungal infections (IFIs).

Recent Findings

Cryptococcal meningitis has the largest body and highest quality in support of combination therapy with amphotericin B and flucytosine. More recent data in treatment of invasive aspergillosis suggest combination therapy with voriconazole and echinocandins may be effective in select patients. Quality studies are needed to define combination therapy in rare mold infections.

Summary

Multiple strategies have been employed to optimize treatment of the growing incidence of IFIs. With exceptions as noted above, justification for the use of combination antifungal therapy is most often based on uncontrolled and/or underpowered studies, in vitro data, and case reports.

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    Correspondence to Spencer J. Livengood.

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    Conflict of Interest

    John Perfect reports grants and being a member of the advisory board for Merck; grants from Astellas, serving on the advisory board for F2G, serving on the advisory board, and consulting for Scynexis; grants from Pfizer; grants from Amplyx, serving on the advisory board and consulting for Ampili; and grants from Minnetronix, serving on the advisory board for Matinas outside the submitted work. Richard Drew reports expenses for CME presentation from American Society of Microbiology, consultant fees from Paratek, and publication royalties from UpToDate. Spencer Livengood declares no conflicts of interest relevant to this manuscript.

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    Livengood, S.J., Drew, R.H. & Perfect, J.R. Combination Therapy for Invasive Fungal Infections. Curr Fungal Infect Rep (2020) doi:10.1007/s12281-020-00369-4

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    Keywords

    • Combination antifungals
    • Invasive fungal infections
    • Antifungal synergy
    • Aspergillosis
    • Cryptococcus
    • Candidiasis