Treatment of systemic fungal infections in older patients - Achieving optimal outcomes

Systemic fungal infections are an increasing problem in older adults. For s everal of the endemic mycoses, this increase is the result of increased tra vel and leisure activities in areas endemic for these fungi. Immunosuppress ive agents, care in an intensive care unit, and invasive devices all contri bute to infection with opportunistic fungi. Treatment of systemic fungal in fections is usually with an azole or amphotericin B. The preferred regimen depends on the specific fungal infection. the site and the severity of the infection, the state of immunosuppression of the patient and the possible t oxicities of each drug for a specific patient. In older adults, drug-drug i nteractions between the azoles and drugs commonly prescribed for older pers ons may lead to serious toxicity, and absorption of itraconazole can be pro blematic. Amphotericin B is associated with significant nephrotoxicity, esp ecially in older adults with pre-existing renal disease, and infusion-relat ed adverse effects. Newer lipid formulations of amphotericin B can obviate some of these toxicities, but their role in the treatment of systemic funga l infections in older adults has not yet been clarified.