JAC Advance Access originally published online on September 16, 2004
Journal of Antimicrobial Chemotherapy 2004 54(5):854-869; doi:10.1093/jac/dkh434
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
JAC vol.54 no.5 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved
Review |
Combinations of antifungal agents in therapy–what value are they?
Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain
* Tel: +34-91-5097961; Fax: +34-91-5097966; Email: mcuenca-estrella{at}isciii.es
Concurrent or sequential antifungal treatment for invasive mycoses has been typically considered as an option to improve results of monotherapy. However, data on the efficacy of combination therapy are sparse and consist largely of results from studies in vitro and experimental animal models. These studies have yielded controversial results depending on the criteria used to evaluate the antifungal interaction. Several combinations that showed synergy in vitro failed to do so in animal models. Overall, apart from cryptococcal infections, combined antifungal therapy is not significantly better than monotherapy in terms of clinical efficacy. It is questionable whether combination therapy should be used in most cases as there is a lack of evidence from well-designed clinical trials. However, combination therapy could be an alternative to monotherapy for patients with invasive infections that are difficult to treat, such as those due to multi-resistant species and for those who fail to respond to standard treatment.
Keywords: concurrent antifungal treatments , interactions in vitro of antifungal agents , clinical efficacy of antifungal combinations
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. S. Cavalheiro, G. Maboni, M. I. de Azevedo, J. S. Argenta, D. I. B. Pereira, T. B. Spader, S. H. Alves, and J. M. Santurio In Vitro Activity of Terbinafine Combined with Caspofungin and Azoles against Pythium insidiosum Antimicrob. Agents Chemother., May 1, 2009; 53(5): 2136 - 2138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. I. Morris Posaconazole: A new oral antifungal agent with an expanded spectrum of activity Am. J. Health Syst. Pharm., February 1, 2009; 66(3): 225 - 236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. P.-H. Chang, P.-L. Sun, F.-Y. Huang, T.-C. Tsai, C.-C. Lin, M.-D. Lee, Y.-C. Chen, J.-C. Sheu, and J.-D. Tsai Paecilomyces lilacinus peritonitis complicating peritoneal dialysis cured by oral voriconazole and terbinafine combination therapy J. Med. Microbiol., December 1, 2008; 57(12): 1581 - 1584. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Lignell, E. Lowdin, O. Cars, and J. Sjolin Characterization of the inhibitory effect of voriconazole on the fungicidal activity of amphotericin B against Candida albicans in an in vitro kinetic model J. Antimicrob. Chemother., July 1, 2008; 62(1): 142 - 148. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Chaturvedi, R. Ramani, M. A. Ghannoum, S. B. Killian, N. Holliday, C. Knapp, L. Ostrosky-Zeichner, S. A. Messer, M. A. Pfaller, N. J. Iqbal, et al. Multilaboratory Testing of Antifungal Combinations against a Quality Control Isolate of Candida krusei Antimicrob. Agents Chemother., April 1, 2008; 52(4): 1500 - 1502. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Argenta, J. M. Santurio, S. H. Alves, D. I. B. Pereira, A. S. Cavalheiro, A. Spanamberg, and L. Ferreiro In Vitro Activities of Voriconazole, Itraconazole, and Terbinafine Alone or in Combination against Pythium insidiosum Isolates from Brazil Antimicrob. Agents Chemother., February 1, 2008; 52(2): 767 - 769. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cacciapuoti, J. Halpern, C. Mendrick, C. Norris, R. Patel, and D. Loebenberg Interaction between Posaconazole and Caspofungin in Concomitant Treatment of Mice with Systemic Aspergillus Infection. Antimicrob. Agents Chemother., July 1, 2006; 50(7): 2587 - 2590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Cuenca-Estrella, A. Gomez-Lopez, M. J. Buitrago, E. Mellado, G. Garcia-Effron, and J. L. Rodriguez-Tudela In Vitro Activities of 10 Combinations of Antifungal Agents against the Multiresistant Pathogen Scopulariopsis brevicaulis. Antimicrob. Agents Chemother., June 1, 2006; 50(6): 2248 - 2250. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Bow Of Yeasts and Hyphae: A Hematologist's Approach to Antifungal Therapy Hematology, January 1, 2006; 2006(1): 361 - 367. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. MacCallum, J. A. Whyte, and F. C. Odds Efficacy of Caspofungin and Voriconazole Combinations in Experimental Aspergillosis Antimicrob. Agents Chemother., September 1, 2005; 49(9): 3697 - 3701. [Abstract] [Full Text] [PDF]
|
|