Pharmacotherapy approaches to antifungal prophylaxis

Tzi Bun Ng, Randy Chi Fai Cheung, Xiu Juan Ye, Evandro Fei Fang, Yau Sang Chan, Wen Liang Pan, Xiu Li Dan, Cui Ming Yin, Sze Kwan Lam, Peng Lin, Patrick Hung Kui Ngai, Li Xin Xia, Fang Liu, Xiu Yun Ye, He Xiang Wang, Jack Ho Wong

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations

Abstract

Introduction: Invasive fungal infection (IFI) is a serious problem due to difficulties in early diagnosis and high mortality. Different approaches are adopted for the treatment and management of IFI, including prophylactic, empiric, preemptive and directed strategies. Areas covered: This paper reviews the type of pharmacotherapy used for antifungal prophylaxis in infants with extremely low birth weights, pediatric patients with cardiac disease, preterm neonates, pediatric oncology patients, adult cancer patients with neutropenia, adult patients with hematologic malignancy, hematopoietic stem-cell transplantation recipients, organ transplant recipients, HIV-infected patients, immunosuppressed patients treated with moderate or high doses of corticosteroids, and patients with invasive fusariosis, candidemia, invasive candidiasis, systemic mycoses and immunocompromised patients. Expert opinion: Azole drugs are the drugs most often used in cost-effective antifungal prophylaxis of patients with conditions such as immunodeficiency and cancer, which render them highly susceptible to IFI. Fluconazole is the most outstanding example. However, there are many azoles with different pharmacological characteristics that the physician can choose from. Echinocandins have favorable characteristics that make them useful for treating Candida infections. Antibodies, or their engineered derivatives directed against cell-wall polysaccharides and glycopeptides, and some protein epitopes of Candida albicans, appear to be a promising novel approach for prophylaxis against Candida infection and deserve further in-depth investigations.

Original languageEnglish (US)
Pages (from-to)1695-1705
Number of pages11
JournalExpert Opinion on Pharmacotherapy
Volume13
Issue number12
DOIs
StatePublished - Aug 2012
Externally publishedYes

Bibliographical note

Funding Information:
The authors declare no conflict of interest. The award of a research grant (Research Funds for the Control of Infectious Diseases, project reference no. 10090812) by Food and Health Bureau, the Government of Hong Kong Special Administrative Region, is gratefully acknowledged.

Keywords

  • Amphotericin
  • Antifungal prophylaxis
  • Azoles
  • Cost-effectiveness
  • Drug therapy
  • Echinocandins

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