JAC Advance Access published online on September 16, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh434
© 2004 by The British Society for Antimicrobial Chemotherapy
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1 Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain
* To whom correspondence should be addressed. E-mail: 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.
Revised August 11, 2004
Accepted August 18, 2004
Review
Combinations of antifungal agents in therapy-what value are they?
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