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Updates in the Treatment of Breakthrough Mold Infections

  • Pharmacology and Pharmacodynamics of Antifungal Agents (J Amsden, Section Editor)
  • Published:
Current Fungal Infection Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Patients on antifungal therapy who develop breakthrough mold infections pose significant treatment challenges for clinicians. Treatment of these infections demands a multimodal approach, including a thorough patient assessment, immune restoration, and evaluation for nonadherence and drug–drug interactions. However, limited clinical trial data are available to guide therapeutic decision-making.

Recent Findings

Organisms associated with breakthrough mold infection have historically included Aspergillus species and the Mucorales; however, rare and resistant molds are increasing in prevalence. Treatment failure and mortality rates remain high with breakthrough infection, irrespective of the selected treatment. Therapeutic drug monitoring, dose optimization, and combination antifungal therapy have been increasingly used to treat refractory cases.

Summary

Switch therapy and combination antifungal therapy represent the major treatment strategies for breakthrough mold infection. Herein, preclinical and clinical data are reviewed supporting the merits of each approach. Additionally, recommendations for therapeutic drug monitoring are provided.

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Authors and Affiliations

  1. Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale, AZ, USA

    Kellie J. Goodlet & Kelsey Spadafora

  2. Division of Transplant Pulmonology, Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Rajat Walia

  3. Department of Pharmacy Services, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA

    Michael D. Nailor

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Michael Nailor reports personal fees from Astellas for consulting outside the submitted work. Rajat Walia reports personal fees from Astellas outside the submitted work. Kellie Goodlet and Kelsey Spadafora declare no conflicts of interest relevant to this manuscript.

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Goodlet, K.J., Spadafora, K., Walia, R. et al. Updates in the Treatment of Breakthrough Mold Infections. Curr Fungal Infect Rep 14, 153–165 (2020). https://doi.org/10.1007/s12281-020-00387-2

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