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      Broad spectrum triazoles for invasive mould infections in adults: Which drug and when?

      1 , 2 , 2 , 3

      Medical Mycology

      Oxford University Press (OUP)

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          Abstract

          <p class="first" id="d247038e89">Invasive mould infections are an increasing cause of morbidity and mortality globally, mainly due to increasing numbers of immunocompromised individuals at risk for fungal infections. The introduction of broad spectrum triazoles, which are much better tolerated compared to conventional amphotericin B formulations, has increased survival, particularly in invasive mould infection. However, early initiation of appropriate antifungal treatment remains a major predictor of outcome in invasive mould infection, but despite significant advances in diagnosis of these diseases, early diagnosis remains a challenge. As a result, prophylaxis with mould-active triazoles is widely used for those patients at highest risk for invasive mould infection, including patients with prolonged neutropenia after induction chemotherapy for acute myeloid leukemia and patients with graft-versus-host-disease. Posaconazole is the recommended drug of choice for antimould prophylaxis in these high-risk patients. Voriconazole has its primary role in treatment of invasive aspergillosis but not in prophylaxis. Recently, isavuconazole has been introduced as an excellent alternative to voriconazole for primary treatment of invasive aspergillosis in patients with hematological malignancies. Compared to voriconazole, isavuconazole and posaconazole have broader activity against moulds and are therefore also an option for treatment of mucormycosis in the presence of intolerance or contraindications against liposomal amphotericin B. </p>

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          Author and article information

          Journal
          Medical Mycology
          Oxford University Press (OUP)
          1369-3786
          1460-2709
          April 2019
          April 01 2019
          February 28 2019
          April 2019
          April 01 2019
          February 28 2019
          : 57
          : Supplement_2
          : S168-S178
          Affiliations
          [1 ]Department of Medicine, University of California–San Diego, San Diego, California, USA
          [2 ]Division of Infectious Diseases, Department of Medicine, University of California–San Diego, San Diego, California, USA
          [3 ]Section of Infectious Diseases and Tropical Medicine AND Division of Pulmonology, Medical University of Graz, Graz, Austria
          Article
          10.1093/mmy/myy052
          30816967
          6309f1cd-92fa-4fbb-9867-be4d140f2a2d
          © 2019

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