Systemic fungal infections in patients with hematologic malignancies: Indications and limitations of the antifungal armamentarium

The rates of fungal infections have increased substantially in Europe as we ll as in North America. Most frequently Aspergillus spp. and Candida spp. a re isolated. Despite the recent introduction of new azoles and lipid-based formulations of amphotericin B, there are relatively few randomized, contro lled studies on the use of antifungal drugs in patients with hematological malignancies and invasive fungal infections. Conventional amphotericin B is considered the gold standard for the treatment of invasive fungal infectio ns; however, adverse events limit conventional amphotericin B treatment. Th e newer azoles, fluconazole and itraconazole, are well tolerated; however, fluconazole has no activity against Aspergillus spp. An additional serious problem is the emerging resistance of nonalbicans Candida spp, to fluconazo le. In this situation, lipid formulations of amphotericin B seem to be attr active, since the use of these drugs has been shown to be safe and effectiv e. Considerably higher medical costs limit broader application of lipid for mulations of amphotericin B. Because of the rapidly increasing incidence of serious fungal infections, we have reviewed current strategies and the rol e of newer antifungal drugs for the treatment of deep-organ infections.