Universität zu Köln

Schwarz, Patrick ORCID: 0000-0003-0383-1865, Cornely, Oliver A. and Dannaoui, Eric (2019). Antifungal combinations in Mucorales: A microbiological perspective. Mycoses, 62 (9). S. 746 - 761. HOBOKEN: WILEY. ISSN 1439-0507

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Abstract

Mucormycosis mostly affects immunocompromised patients and is associated with a high morbidity and mortality despite currently available treatments. In that context, combination therapy might be the key to a better outcome for these patients. Purpose of this review is to summarise and to discuss the current combination data obtained in vitro, in vivo in animal models of mucormycosis, and in patients. In vitro combination studies showed that most of the interactions between antifungal drugs were indifferent, even though that some synergistic interactions were achieved for the combination of echinocandins with either azoles or amphotericin B. Importantly, antagonism was never observed. Animal models of mucormycosis focused on infections caused by Rhizopus arrhizus, neglecting most other species responsible for human disease. In these experimental animal models, no strong interactions have been demonstrated, although a certain degree of synergism has been reported in some instances. Combinations of antifungals with non-antifungal drugs have also been largely explored in vitro and in animal models and yielded interesting results. In patients with ketoacidosis and rhino-orbito-cerebral infection, combination of polyene with caspofungin was effective. In contrast, despite promising experimental data, adjunctive therapy with the iron chelator deferasirox was unfavourable and was associated with a higher mortality than monotherapy with liposomal amphotericin B. More combinations have to be tested in vitro and a much larger panel of Mucorales species has to be tested in vivo to give a valuable statement if antifungal combination therapy could be an effective treatment strategy in patients with mucormycosis.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schwarz, Patrick UNSPECIFIED orcid.org/0000-0003-0383-1865 UNSPECIFIED Cornely, Oliver A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dannaoui, Eric UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-134919
DOI:	10.1111/myc.12909
Journal or Publication Title:	Mycoses
Volume:	62
Number:	9
Page Range:	S. 746 - 761
Date:	2019
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1439-0507
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LIPOSOMAL AMPHOTERICIN-B; IN-VITRO SUSCEPTIBILITIES; ORGAN TRANSPLANT RECIPIENTS; STEM-CELL TRANSPLANTATION; CRYPTOCOCCUS-NEOFORMANS; DISSEMINATED MUCORMYCOSIS; IRON CHELATOR; IMMUNOSUPPRESSIVE DRUGS; PULMONARY MUCORMYCOSIS; RHIZOPUS-MICROSPORUS Multiple languages Dermatology; Mycology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13491