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Problems in Antifungal Chemotherapy

Probleme der antimykotischen Therapie

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Summary

The field of antifungal chemotherapy is undergoing rapid change at present, with an accelerating pace of introduction of new agents. The problems at present include the need for more effective agents, particularly with novel modes of action. Fungal infection must be considered more frequently in differential diagnosis, and methods developed for early diagnosis. The literature must be improved, with more precise terms. Trials comparing agents are needed, as are studies directed at determining the appropriate length of therapy.In vitro susceptibility testing must be standardized, and clinical correlations examined. Particular problem areas in current therapy are deep candida infections, zygomycotic infections, fungal endocarditis and meningitis, cryptococcosis in AIDS patients, and ocular infections withFusarium species. Immunomodulating or “pro-host” drugs present an as yet unexplored avenue for clinical therapy. Regimes to prevent fungal infection need improvement. Until the needed advances occur, we must be resourceful in minimizing the toxicity of the agents presently available.

Zusammenfassung

Auf dem Gebiet der antimykotischen Chemotherapie vollzieht sich zur Zeit ein rascher Wandel. In immer kürzeren Abständen werden neue Substanzen eingeführt. Doch werden weiterhin wirksamere Medikamente mit neuem Wirkungsmechanismus benötigt. Pilzinfektionen sollten in der Differentialdiagnose häufiger bedacht und Methoden für eine Frühdiagnostik entwickelt werden. Publikationen sind im Hinblick auf eine präzisere Terminologie verbesserungsbedürftig. Vergleichende Therapiestudien und Studien, die die erforderliche Therapiedauer bestimmen, sollten durchgeführt werden. Es ist erforderlich, dieIn vitro-Empfindlichkeitstestung zu standardisieren und die Ergebnisse zur klinischen Wirksamkeit eines Antimykotikums in Beziehung zu setzen. Besondere Probleme stellt derzeit die Behandlung tiefer Candida-Infektionen, von Infektionen durch Zygomyceten, der Pilz-Endokarditis und -Meningitis, der Kryptokokkose bei AIDS-Patienten und von Augeninfektionen durchFusarium Spezies dar. Unerforscht sind noch die Möglichkeiten immunmodulierender, die körpereigene Abwehr stärkender Medikamente für die Klinik. Die Therapieschemata zur Verhütung von Pilzinfektionen sind verbesserungsbedürftig. Bis die nötigen Fortschritte erreicht sind, müssen wir mit den derzeit verfügbaren Medikamenten sorgfältig umgehen, um ihre Toxizität möglichst gering zu halten.

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  1. Department of Medicine, Santa Clara Valley Medical Center, 751 S. Bascom Ave., 95128, San Jose, CA, USA

    D. A. Stevens M. D.

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Stevens, D.A. Problems in Antifungal Chemotherapy. Infection 15, 87–92 (1987). https://doi.org/10.1007/BF01650203

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