Infection and Drug Resistance (Apr 2023)
Salvage Treatment for Invasive Aspergillosis and Mucormycosis: Challenges, Recommendations and Future Considerations
Abstract
Matthias Egger,1,2 Romuald Bellmann,3 Robert Krause,1,2 Johannes Boyer,1 Daniela Jakšić,4 Martin Hoenigl1,2,5,6 1Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria; 2Biotechmed-Graz, Graz, Austria; 3Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria; 4Department of Microbiology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia; 5Clinical and Translational Fungal-Working Group, University of California San Diego, San Diego, CA, USA; 6Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, AustriaCorrespondence: Martin Hoenigl, Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria, Tel +43 31638531425, Email [email protected]: Invasive mold diseases are devastating systemic infections which demand meticulous care in selection, dosing, and therapy monitoring of antifungal drugs. Various circumstances regarding PK/PD properties of the applied drug, resistance/tolerance of the causative pathogen or host intolerability can lead to failure of the initial antifungal therapy. This necessitates treatment adaption in the sense of switching antifungal drug class or potentially adding another drug for a combination therapy approach. In the current state of drastically limited options of antifungal drug classes adaption of therapy remains challenging. Current guidelines provide restricted recommendations only and emphasize individual approaches. However, novel antifungals, incorporating innovative mechanisms of action, show promising results in late stage clinical development. These will expand options for salvage therapy in the future potentially as monotherapy or in combination with conventional or other novel antifungals. We outline current recommendations for salvage therapy including PK/PD considerations as well as elucidate possible future treatment options for invasive aspergillosis and mucormycosis.Keywords: invasive fungal infections, aspergillosis, mucormycosis, salvage therapy
