Effective treatment of fungal infections: A Synthesis of Findings from 19 Studies

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Original Abstract of the Article

Major Research Findings

Fungal infections have become a growing concern for patients undergoing intensive myelosuppressive therapy for hematologic malignancies. 3 These infections, especially those occurring during prolonged neutropenia, can significantly contribute to infectious complications and early death. 3 Therefore, early detection and effective prophylactic strategies using active and nontoxic antifungal agents are urgently needed. 3

Research has shown that newer antifungal medications like liposomal amphotericin B and caspofungin may be more effective and less toxic than traditional amphotericin B. 4 、 10 、 14 、 5 These medications have demonstrated effectiveness in preventing and treating fungal infections in critically ill patients and those with weakened immune systems. 11 、 13

Treatment Summary

Studies have explored the use of various antifungal medications, including liposomal amphotericin B, caspofungin, voriconazole, and fluconazole, in the treatment of fungal infections. 4 、 10 、 14 、 5 、 15 、 12 、 6 、 8 、 1 These medications have shown promise in both preventing and treating fungal infections. 3 、 11 、 13

Benefits and Risks

Benefits Summary

Newer antifungal medications have shown effectiveness and fewer side effects compared to traditional amphotericin B. 4 、 10 、 14 、 5 、 15 They have also been effective in preventing and treating fungal infections. 3 、 11 、 13

Risks Summary

Antifungal medications can have side effects. 4 、 10 、 14 、 5 、 15 、 12 、 6 、 8 、 1 Therefore, it's crucial to consult a doctor when considering antifungal medication.

Comparison Between Studies

Similarities Between Studies

Many studies have demonstrated that newer antifungal medications are more effective and have fewer side effects compared to traditional amphotericin B. 4 、 10 、 14 、 5 、 15

Differences Between Studies

Different antifungal medications and patient populations were used in each study, which may have influenced the results. 4 、 10 、 14 、 5 、 15 、 12 、 6 、 8 、 1 Therefore, it's essential to consider the results comprehensively.

Consistency and Contradictions in Results

Many studies have shown that newer antifungal medications are more effective and have fewer side effects than traditional amphotericin B. 4 、 10 、 14 、 5 、 15 However, some studies have reported side effects with newer antifungal medications. 12 、 6 、 8 、 1 Therefore, it's essential to weigh the potential risks when considering using newer antifungal medications.

Practical Application Considerations

Fungal infection prevention and treatment depend on the patient's condition and the type of infection. 7 、 9 、 17 Therefore, it's crucial to seek medical advice if you suspect a fungal infection.

Current Research Limitations

Research on fungal infection treatment is still ongoing. 7 、 9 、 17 Further research is needed, especially on the long-term effects and side effects of newer antifungal medications.

Future Research Directions

Ongoing research on fungal infection prevention and treatment is crucial. 7 、 9 、 17 The development of new antifungal medications and clinical trials are particularly important.

Conclusion

Fungal infections pose a significant challenge for patients undergoing immunosuppressive therapy. 3 、 18 、 4 、 10 、 14 、 8 Newer antifungal medications have shown promise with greater effectiveness and fewer side effects compared to traditional amphotericin B. 4 、 10 、 14 、 5 、 15 However, the treatment of fungal infections is complex, and the best approach varies depending on the patient's condition and the type of infection. 7 、 9 、 17 It is crucial to seek medical advice when considering treatment options.

Treatment List

Liposomal amphotericin B, caspofungin, voriconazole, fluconazole

Literature analysis of 19 papers
Positive Content
19
Neutral Content
0
Negative Content
0
Article Type
7
7
9
8
19
1.

The use of fluconazole prophylaxis in patients with chemotherapy-induced neutropenia.

Author: WingardJ R

Candida infection treatment
Amphotericin B toxicity

Candida infections are a significant cause of complications and death during chemotherapy. Early diagnosis is challenging, and treatment of established Candida infections is often unsuccessful, with high mortality rates. While amphotericin B has been used to prevent fungal infections, its toxicity limits its effectiveness. Fluconazole, when given as a preventative measure during chemotherapy, has proven safe and effective, but it is not effective against all types of fungi, particularly Aspergillus and some less virulent Candida species. Further research is needed to determine if these limitations will impact the long-term usefulness of fluconazole.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

3.

Failure of fluconazole prophylaxis to reduce mortality or the requirement of systemic amphotericin B therapy during treatment for refractory acute myeloid leukemia: results of a prospective randomized phase III study. German AML Cooperative Group.

Author: KernW, BehreG, RudolfT, KerkhoffA, Grote-MetkeA, EimermacherH, KubicaU, WörmannB, BüchnerT, HiddemannW

Improved understanding of invasive fungal infections

Fungal infections are becoming a greater concern for people undergoing intensive treatment for blood cancers. These infections, particularly those that occur when the body’s white blood cell count is low, can lead to serious complications and death. Early detection methods and safe, effective preventive measures with antifungal medications are urgently needed.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

4.

Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group.

Author: WalshT J, FinbergR W, ArndtC, HiemenzJ, SchwartzC, BodensteinerD, PappasP, SeibelN, GreenbergR N, DummerS, SchusterM, HolcenbergJ S

Breakthrough fungal infection reduction
Infusion-related toxicity reduction
Nephrotoxicity reduction

Liposomal amphotericin B is as effective as conventional amphotericin B for empirical antifungal therapy in patients with fever and neutropenia, and it is associated with fewer breakthrough fungal infections, less infusion-related toxicity, and less nephrotoxicity. In a randomized, double-blind, multicenter trial comparing liposomal amphotericin B with conventional amphotericin B, the composite rates of successful treatment were similar (50 percent for liposomal amphotericin B and 49 percent for conventional amphotericin B). There were fewer proved breakthrough fungal infections among patients treated with liposomal amphotericin B (11 patients [3.2 percent]) than among those treated with conventional amphotericin B (27 patients [7.8 percent]). Liposomal amphotericin B was associated with fewer infusion-related fever, chills or rigors, and other reactions. Nephrotoxic effects were significantly less frequent among patients treated with liposomal amphotericin B (19 percent) than among those treated with conventional amphotericin B (34 percent).

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

5.

Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia.

Author: WalshThomas J, TepplerHedy, DonowitzGerald R, MaertensJohan A, BadenLindsey R, DmoszynskaAnna, CornelyOliver A, BourqueMichael R, LupinacciRobert J, SableCarole A, dePauwBen E

Fungal infection prevention
Fungal infection treatment

This study explores caspofungin, a new antifungal medication, as a potential alternative treatment for patients with persistent fever and low white blood cell count (neutropenia), who are often treated with amphotericin B to prevent or treat fungal infections. The study suggests that caspofungin may be a better-tolerated option compared to amphotericin B.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Antifungal treatment for invasive Candida infections: a mixed treatment comparison meta-analysis.

Author: MillsEdward J, PerriDan, CooperCurtis, NachegaJean B, WuPing, TleyjehImad, PhillipsPeter

Invasive candidiasis treatment

Different antifungal therapies for invasive candidiasis offer preferential effects on response rates and mortality.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Antifungal therapy in infants and children with proven, probable or suspected invasive fungal infections.

Author: BlythChristopher C, HaleKatherine, PalasanthiranPamela, O'BrienTracey, BennettMichael H

Lipid amphotericin B less nephrotoxicity
Amphotericin B infusion reactions

Limited paediatric data are available comparing antifungal agents in children with proven, probable or suspected invasive fungal infection. No differences in mortality or treatment efficacy were observed when antifungal agents were compared.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

Pharmacoeconomics of voriconazole.

Author: Rubio-TerrésCarlos, GrauSantiago

IFI treatment

The use of cancer medications, immune-suppressing drugs, broad-spectrum antibiotics, implants, organ transplants, and more complex surgeries has led to an increase in serious fungal infections. New antifungal medications have become available to treat these infections. This article emphasizes the value of comparing the costs and benefits of different treatments to guide decision-making.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

9.

Antifungal therapy in children: an update.

Author: CecinatiValerio, GuastadisegniChiara, RussoFabio Giovanni, BresciaLetizia Pomponia

Antifungal treatment

This study provides antifungal treatment recommendations for paediatric patients with invasive fungal infections. It reviews the literature and classifies antifungal drugs by their targets, outlining their pharmacokinetic profiles, clinical indications, and side effects. The review aims to assist clinicians in choosing the most suitable treatment for each specific case, considering the need for immediate therapy before cultures are available.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

A randomized comparative trial evaluating the safety and efficacy of liposomal amphotericin B (Fungisome) versus conventional amphotericin B in the empirical treatment of febrile neutropenia in India.

Author: JadhavM P, ShindeV M, ChandrakalaS, JijinaF, MenonH, AroraB, KurkureP A, ParikhP M, KshirsagarN A

Fungal infection treatment
Breakthrough infections
Toxicity

Liposomal amphotericin B (Fungisome) is equally efficacious and safer than conventional amphotericin B for the treatment of febrile neutropenia.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

11.

Antifungal agents for preventing fungal infections in non-neutropenic critically ill patients.

Author: CortegianiAndrea, RussottoVincenzo, MaggioreAlessandra, AttanasioMassimo, NaroAlessandro R, RaineriSanti Maurizio, GiarratanoAntonino

Early antifungal therapy

Fungal infections are a significant cause of illness and death in critically ill patients. Early treatment with antifungals is crucial to reduce deaths. While testing for specific fungi takes time, guidelines have discussed using general antifungal treatment when a fungal infection is suspected, even without confirmation. This updated review provides more information for treating critically ill patients who are not neutropenic and have a suspected fungal infection, based on recent research.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

12.

Voriconazole pharmacokinetics following HSCT: results from the BMT CTN 0101 trial.

Author: HopeWilliam W, WalshThomas J, GoodwinJoanne, PeloquinCharles A, HowardAlan, KurtzbergJoanne, MendizabalAlan, ConferDennis L, BulittaJürgen, BadenLindsey R, NeelyMichael N, WingardJohn R,

Fungal infection prevention

This pharmacokinetic-pharmacodynamic substudy of a randomized clinical trial investigating voriconazole for the prevention of invasive fungal infections in hematopoietic stem cell transplant (HSCT) recipients found no statistically significant relationship between drug exposure and the probability of breakthrough infection. Due to the limited number of infections, further research is needed to better understand the relationship between drug exposure and infection prevention.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

13.

Safety and effectiveness of antifungal prophylaxis in preventing fungal infection after liver transplantation: a meta-analysis of randomized clinical trials.

Author: XingTonghai, ZhongLin, PengZhihai

Fungal infection prevention

Antifungal prophylaxis effectively reduced the risk of invasive fungal infections in patients who underwent liver transplantation, with a 0.41 odds ratio for defined invasive fungal infection.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

14.

Cost-effectiveness of caspofungin versus liposomal amphotericin B in the treatment of systemic fungal infections: a systematic review of economic analyses.

Author: MistroSóstenes, RosaLorena, GomesBárbara, MirandaLígia, BadaróRoberto

Fungal infection treatment

Treating fungal infections in critically ill patients is a major challenge globally, both clinically and financially. Liposomal amphotericin B and caspofungin are very effective antifungal drugs, but they are also expensive. Health systems need to choose the drug that provides the best patient outcomes while being affordable.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

15.

Efficacy and safety of caspofungin in children: systematic review and meta-analysis.

Author: RosanovaMaría T, BesDavid, Serrano AguilarPedro, Cuellar PompaLeticia, SbernaNorma, LedeRoberto

This research examined the use of caspofungin, an echinocandin, as an alternative treatment for invasive fungal infections in children. While caspofungin is an option, more research is needed to understand its efficacy and safety compared to standard treatments.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

16.

Efficacy and safety of voriconazole in immunocompromised patients: systematic review and meta-analysis.

Author: RosanovaMaria Teresa, BesDavid, Serrano AguilarPedro, SbernaNorma, LedeRoberto

IFI treatment

This study compared the efficacy and safety of voriconazole with other antifungals in the prophylaxis or treatment of invasive fungal infections (IFIs) in patients at high risk.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

17.

Choosing the Right Antifungal Agent in ICU Patients.

Author: ChatelonJeanne, CortegianiAndrea, HammadEmmanuelle, CassirNadim, LeoneMarc

Improved IFI outcomes
Dosage challenges
Drug interactions

Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality in intensive care units (ICUs). This review summarizes the features of commonly used antifungal treatments for non-neutropenic ICU patients, including polyenes, azoles, and echinocandins. The review also highlights the challenges associated with antifungal treatment in ICU patients, including pharmacokinetic changes and drug interactions.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

18.

Intravenous itraconazole compared with liposomal amphotericin B as empirical antifungal therapy in patients with neutropaenia and persistent fever.

Author: YoshidaIsao, SaitoAkiko M, TanakaShiro, ChoiIlseung, HidakaMichihiro, MiyataYasuhiko, InoueYoshiko, YamasakiSatoshi, KagooToshiya, IidaHiroatsu, NiimiHiromasa, KomenoTakuya, YoshidaChikamasa, TajimaFumihito, YamamotoHideyuki, TakaseKen, UenoHironori, ShimomuraTakeshi, SakaiTatsunori, NakashimaYasuhiro, YoshidaChikashi, KubonishiShiro, SunamiKazutaka, YoshidaShinichiro, SakuraiAki, KanekoYukihiro, MiyazakiYoshitsugu, NagaiHirokazu

Fungal infection treatment
Breakthrough infection

Intravenous itraconazole showed similar efficacy and safety as liposomal amphotericin B as empirical antifungal therapy in hematological malignancy patients with febrile neutropenia. However, the small sample size limited the ability to demonstrate non-inferiority.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

19.

(1→3)-β-D-glucan testing for the detection of invasive fungal infections in immunocompromised or critically ill people.

Author: WhiteSandra K, SchmidtRobert L, WalkerBrandon S, HansonKimberly E

IFI detection

(1→3)-β-D-glucan (BDG) is a component of the fungal cell wall that can be detected in the serum of individuals with invasive fungal infections (IFIs). The serum BDG test is a valuable tool for the early detection of IFIs, leading to prompt treatment and reduced morbidity and mortality.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

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