Current and potential treatment options for invasive Candida infections

ABSTRACT

Introduction: Milestones in the history of antifungal development have only been partially able to alter the severity of prognosis associated with invasive candidiasis. This review aims to address current therapeutic strategies in the treatment of invasive candidiasis, their strengths and weaknesses, and present novel antifungals and clinical evidence of their potential.

Areas covered: Candidemia, the most frequently encountered form of invasive candidiasis, is associated with an aggravated prognosis. Besides the obvious unfavourable host factors present in patients with severe underlying pathology, microbe characteristics, such as the ability to form immune system evading biofilm structures, or the emergence of resistance, further impact prognosis. The utility of biochemical markers and diagnostic techniques for a prompt and accurate diagnosis is discussed. Moreover, historical and up to date pharmacological and clinical efficacy data of licensed antifungals are reviewed, and their individual properties analyzed. Therapeutic gaps are emphasized and current evidence on the contribution of evolving treatments is discussed.

Expert opinion: Difficult sites of infection such as bone, central nervous system and foreign body associated Candida biofilms are sub-optimally managed. Combination regimens and new promising antifungals are currently investigated. In view of new epidemiological data and evolving resistance rates, antifungal stewardship appears necessary.

KEYWORDS:

• Candidiasis
• therapy
• Candida albicans
• Candida parapsilosis

Article highlights

• Changes in epidemiology of Candida species and emergence of new species occur and may cause changes in treatment strategies

• Conventional antifungal agents still keep their antifungal activity, however they have toxicity (amphotericin B) or activity limitations (azoles)

• New antifungal agents have been marketed or are under development, such as isavuconazole and enfumafungin

• Combination therapy is not usually indicated in the treatment of invasive candidiasis

This box summarizes key points contained in the article.

Declaration of interest

E Roilides is an independent contractor and has received research grants of significant value from Astellas, Gilead, Pfizer. Speaker’s Bureau from Astellas, Gilead, Merck, Pfizer. Has acted as Scientific Advisor (Review Panel or Advisory Committee) for Astellas, Gilead, Pfizer, Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.