Duration of antifungal treatment in mold infection: when is enough?

IF 3.6 3区医学 Q2 INFECTIOUS DISEASES

Current Opinion in Infectious Diseases Pub Date : 2023-12-01 Epub Date: 2023-09-19 DOI:10.1097/QCO.0000000000000972

Vera Portillo, Dionysios Neofytos

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引用次数: 0

Abstract

Purpose of review: Although invasive mold infections (IMI) are a major complication in high-risk populations, treatment duration has not yet been well defined.

Recent findings: Guidelines suggest documenting clinical/radiological resolution and immunological recovery before stopping antifungal treatment, after a minimum duration of treatment of 3 months for invasive pulmonary aspergillosis, while longer (up to 6 months) duration is proposed for the treatment of invasive mucormycosis. However, data on and definitions of clinical/radiological resolution and immune recovery remain scarce. Limited real-life data suggest that often much longer courses of treatment are given, generally in the context of continuous immunosuppression, occasionally defined as secondary prophylaxis. However, clearcut definition and distinction of secondary prophylaxis from antifungal treatment remain to be defined.

Summary: Decisions to stop antifungal treatment are based on poorly defined treatment responses and immune reconstitution and experts' opinions. More evidence is needed to determine the optimal duration of treatment of IMI. Well designed, easy to use, and realistic algorithms to help clinicians decide when to stop antifungal treatment are urgently needed.

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霉菌感染的抗真菌治疗持续时间：什么时候足够？

综述目的：尽管侵袭性霉菌感染（IMI）是高危人群的主要并发症，但治疗持续时间尚未明确。最近的研究结果：指南建议在停止抗真菌治疗之前，在至少3个疗程后，记录临床/放射学解决方案和免疫恢复侵袭性肺曲霉菌病的发病时间为月，而发病时间更长（最多6个月月）的持续时间用于治疗侵袭性毛霉菌病。然而，关于临床/放射学分辨率和免疫恢复的数据和定义仍然很少。有限的真实数据表明，通常在持续免疫抑制的情况下，给予更长的疗程，偶尔被定义为二级预防。然而，二级预防和抗真菌治疗的明确定义和区别仍有待定义。总结：停止抗真菌治疗的决定是基于不明确的治疗反应和免疫重建以及专家的意见。需要更多的证据来确定IMI的最佳治疗持续时间。迫切需要设计良好、易于使用和现实的算法来帮助临床医生决定何时停止抗真菌治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Infectious Diseases 医学-传染病学

CiteScore

6.70

自引率

2.60%

发文量

121

审稿时长

6-12 weeks

期刊介绍： This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.