Antifungal therapy in invasive fungal infections

Early treatment of invasive fungal infections (IFIs) is essential for optimal clinical outcomes. Standard antifungal drugs (polyenes, azoles and echinocandins) are not predictably effective against emerging yeasts and filamentous fungi and may cause undesirable side effects. Species identification can guide antifungal selection for invasive candidiasis, but not less common moulds such as Scedosporium and Fusarium spp. Management strategies targeted to those at highest risk (prophylaxis), those with clinical signs of infection not responsive to antibacterials (empiric therapy) and those with occult infection (asymptomatic but with positive fungal biomarkers) produce better outcomes than therapy predicated on identification of a fungal pathogen, but require comparative evaluation. Appropriate dosing and consideration of pharmacokinetic parameters (including therapeutic drug monitoring) are important with newer triazoles. New therapies such as addition of the iron chelator, deferasirox, in the treatment of zygomycosis in diabetic patients, appear promising but additional agents with new targets of action are urgently needed.