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Azole-Resistant Aspergillus and Echinocandin-Resistant Candida: What Are the Treatment Options?

  • Pharmacology and Pharmacodynamics of Antifungal Agents (J Amsden, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review summarizes current treatment options for echinocandin-resistant Candida spp. (ERC) and azole-resistant Aspergillus fumigatus (ARAF), emphasizing recent in vitro/in vivo data, clinical reports, and consensus statements.

Recent Findings

Advances in ERC and ARAF treatment are limited to specific antifungal combinations and dose optimization but remain reliant on amphotericin products. Although novel antifungals may provide breakthroughs in the treatment of resistant fungi, these agents are not yet available. Early identification and appropriate treatment remain a paramount, albeit elusive, task.

Summary

When either ERC or ARAF are suspected or proven, amphotericin products remain the cornerstone of initial therapy. For ERC, azoles are de-escalation options for susceptible isolates in stable patients to avoid amphotericin toxicities. Although combination echinocandin with high-dose salvage posaconazole or isavuconazole may be attempted in ARAF, it requires careful consideration following patient stabilization. Future research defining optimal therapies and early identification of ERC and ARAF is of extreme importance.

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Funding

Study authors are supported by the Colorado Clinical and Translational Sciences Institute (CCTSI). The CCTSI is supported in part by Colorado CTSA Grant UL1TR001082 from NCATS/NIH.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO, 80045, USA

    Alison R. Novak, Mary E. Bradley, Tyree H. Kiser & Scott W. Mueller

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  1. Alison R. Novak
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  2. Mary E. Bradley
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  3. Tyree H. Kiser
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  4. Scott W. Mueller
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Correspondence to Scott W. Mueller.

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Conflict of Interest

Tyree Kiser reports grants from CTSA Grant Number UL1 TR002535 during the conduct of the study; and grants from Astellas, grants from Allergan and grants from Pfizer outside the submitted work. Scott Mueller reports grants from NCATS/NIH CTSA Grant Number UL1 TR002535 which supports the Colorado Clinical and Translational Sciences Institute; from CSL Behring Investigator-Initiated Study, grants from Merck Investigator-Initiated Studies Program; all industry funding has been received by the institution that employs Dr. Mueller, and is outside the submitted work (unrelated to antifungal therapeutics). Alison Novak and Mary Bradley declare no conflicts of interest relevant to this manuscript.

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This article is part of the Topical Collection on Pharmacology and Pharmacodynamics of Antifungal Agents

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Novak, A.R., Bradley, M.E., Kiser, T.H. et al. Azole-Resistant Aspergillus and Echinocandin-Resistant Candida: What Are the Treatment Options?. Curr Fungal Infect Rep 14, 141–152 (2020). https://doi.org/10.1007/s12281-020-00379-2

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