Therapy of invasive fungal infections

During the past decades, the incidence and severity of invasive fungal infe ctions has been increasing. These events have lead to the development of ne w antifungal agents, and amphotericin B no longer is the standard therapy f or a variety of invasive mycoses. Fluconazole has become the drug of choice for treatment of C. albicans infections in non-neutropenic as well as neut ropenic patients. For treatment of cryptococcal meningitis, amphotericin B with flucytosine, followed by fluconazole consolidation therapy is used. Fo r therapy of invasive aspergillosis, the lipid Formulations of amphotericin B may be associated with reduced toxicity and allow for larger doses, alth ough the efficacy of each of the formulations still has to be established i n randomized trials. Finally, treatment modalities aimed at improving host defense mechanisms, including adjunctive therapy with rG-CSF for disseminat ed candidiasis and rG-CSF-elicited granulocyte transfusions, are under way. (C) 1999 Elsevier Science B.V. All rights reserved.