How we approach combination antifungal therapy for invasive aspergillosis and mucormycosis in transplant recipients

Invasive aspergillosis and mucormycosis are life-threatening complications in solid organ and hematopoietic cell transplant recipients. Despite medical advancements in the care of these patients and the availability of new mold-active drugs over the past decade, the outcomes remain suboptimal. Therefore, there has been increased interest in the use of combination antifungal therapy, in hopes that leveraging the possible in vitro synergy of these agents will improve the prognosis of invasive mold disease. However, there has been a large disconnect between the results of experimental and clinical investigations, as clinical studies have not unequivocally demonstrated the superiority of combination therapy over monotherapy. This is particularly true for mucormycosis, where the rarity of the condition has made it nearly impossible to prospectively study novel therapeutic strategies. We review the current standard of antifungal therapy and the preclinical and clinical data addressing the merit of combination therapy, and we provide guidance to optimize the management of these mycoses. Received 4 June 2018. Revision received 22 June 2018. Accepted 26 June 2018. *Address correspondence to: Nina Singh M.D., Infectious Diseases Section, Veterans Affairs Medical Center, University Drive C, Pittsburgh, PA 15240. Tel: +412-360-1688; E-mail: nis5@pitt.edu. AUTHORSHIP GH wrote the first draft of the article. NS made revisions to the article and approved the final draft. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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