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Tratamiento antimicótico combinado: ¿para todos los pacientes y para cualquier micosis? Introduction For systemic mycoses, the potential of combinations began with the appearance of a second major antifungal drug in the 1970’s. Flucytosine (5FC) has a limited spectrum against Candida species, Cryptococcus neoformans, and a few other fungal pathogens. Because of toxicity and limited clinical responses to amphotericin B, flucytosine was evaluated in combination with amphotericin B in the treatment of cryptococcal meningitis. Reduced toxicity and increased efficacy of the combination in this relatively small benchmark study led to the adoption of combined amphotericin B/flucytosine as the standard therapy for cryptococcal meningitis. Just as important, it led to the formation of the Mycoses Study Group (MSG). This National Institutes of Health supported collaborative was formed at the time of the dramatic expansion of HIV/AIDS. The rise of invasive fungal infections (IFI) prompted aggressive development of the azole class of antifungal agents and more recently, the echinocandins. The MSG set about the evaluation of novel antifungal regimens for prevention and treatment of cryptococcosis, the endemic mycoses of North America, systemic candidiasis, and most recently, invasive mold infection. New treatments for cryptococcosis and histoplasmosis have substantially reduced the mortality of these two diseases. In the case of histoplasmosis, this was aided by the development of Histoplasma antigen detection, which decreased the time for diagnosis from weeks to days. As treatment for HIV improved, the incidence and mortality of cryptococcosis and endemic fungal infections also decreased.

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2013-02-11   |   518 visitas   |   Evalua este artículo 0 valoraciones

Vol. 16 Núm.3. Diciembre 2012 Pags. 11-22 Infectio 2012; 16(Supl 3)