Table 5.

Antifungal therapy strategies in recipients of nonpulmonary solid organ transplantation (NP-SOT)

	Strategy	Antifungal agents	References
Prophylaxis	Universal prophylaxis is not recommended Antifungal prophylaxis adapted-to-risk is reasonable High-risk NP-SOT recipients need to be identified in order to prevent the development of IFI	Oral prophylaxis with nonabsorbable antifungal agents (nystatin, clotrimazole, amphotericin B) has shown inconsistent results. Azoles (fluconazole, itraconazole) or Amphotericin B (lipid formulations) or Echinocandins (caspofungin)	Lumbreras et al 1996; Winston et al 1999; Singh et al 2001; Winston and Busuttil 2002; Fortun et al 2003, 2007; Sharpe et al 2003; Hellinger et al 2002, 2005; Munoz et al 2004; Castroagudin et al 2005
Pre-emptive	Strategy not sufficiently validated in these patients Detection of galactomannan antigen of Aspergillus, (1,3)-β-d-glucan or C. albicans germ tube antibodies are not usefulness in NP-SOT recipients	Azoles or Amphotericin B	Akamatsu et al 2007; Perkins 2007
Targeted	Based on sterile site culture results or nonabsolutely sterile samples (respiratory specimens) processed by semi or quantitative methods and considered clinically significant AND/OR Based in histological studies of biopsies and other clinical specimens obtained by instrumental or chirurgic procedures (respiratory and non-respiratory samples)	Azoles or Amphotericin B or Echinocandins Combination therapy (triazole plus echinocandin) in patients with SOTand renal failure or infected by A. fumigatus	Herbrecht 2002; Singh et al 2006a