An appraisal of the current guidelines for the use of antifungals in the treatment of invasive candidiasis, aspergillosis, and mucormycosis

Abstract

mortality in immunocompetent and immunocompromised patients. Despite effective drugs, clinical failures are frequently encountered. Critical factors associated with suboptimal clinical outcome include poor host immune status and delayed diagnosis. Diagnostic sensitivity of the available culture-based methods is not high. Treatment is frequently empiric or pre-emptive particularly for mold infections, based on risk factors, host immunity, non-culture-based diagnostic tests and radiological findings. Treatment guidelines are quite helpful in managing these complicated infections. Published guidelines, recommended by a panel of “experts,” from different regions are available. Despite the fact that such guidelines are based on clinical evidence from several trials, they are not universally applicable in all regions. They are not intended to be. In this chapter, we provide a review of the most recent guidelines available for the management of IFI, with a special focus on Infectious Diseases Society of America (IDSA) guidelines. Appropriateness of applying these guidelines in the Asian setting, and modified recommendations are presented.