Table 2.
Antifungal therapy of selected invasive fungal infections in hemato-oncological patients (modified according to Mousset et al. [2013]; strength of recommendation (SR) and grades indicating the quality of evidence (QE) according to the criteria of the IDSA [Kish, 2001]).
| Invasive aspergillosis | SR/QE# | Invasive candidosis | SR/QE# |
|---|---|---|---|
| First-line treatment of IPA | Candidemia | ||
| Voriconazole | AI | Granulocytopenic patient | |
| Isavuconazole | AI | Echinocandins | BI |
| Liposomal AmB | AII | Liposomal AmB | BI |
| Caspofungin | CII | Nongranulocytopenic patient | |
| Micafungin | CII | Echinocandins | AI |
| ABLC | CIII | Liposomal AmB | AI |
| Anidulafungin + voriconazole | CIII | Voriconazole | AI |
| D-AmB | EI | Fluconazole | AI |
| Second-line treatment of IPA | Hepatosplenic candidosis | ||
| Voriconazole | BII | Granulocytopenic patient | |
| Caspofungin | BII | Liposomal AmB/ABLC | BIII |
| Posaconazole | BII | Echinocandins | BIII |
| Liposomal AmB | BII | Voriconazole | CIII |
| ABLC | BII | Nongranulocytopenic patient | |
| Micafungin | CIII | Fluconazole | BIII |
| Voriconazole + caspofungin | CIII | ||
| Steroids (as adjunctive therapy) | CIII | ||
| CNS infection/sinusitis | |||
| Voriconazole | AII | ||
| Liposomal AmB (⩾5 mg/kg) | BIII | ||
| Surgical intervention (+AF) | AII | ||
| Invasive mucormycosis | SR/QE# | Invasive mucormycosis | SR/QE# |
| First-line treatment | Second-line treatment | ||
| Liposomal AmB (⩾5 mg/kg) | AII | Isavuconazole | AII |
| Isavuconazole | AII | Posaconazole | AII |
| ABLC | BII | Liposomal AmB (⩾5 mg/kg) | BII |
| Posaconazole | BII | ABLC | BII |
| Lipid-based AmB + caspofungin | CIII | Surgical intervention (+AF) | AII |
ABLC, amphotericin B lipid complex; AF, antifungal therapy; AmB, amphotericin B; CNS, central nervous system; D-AmB, Amphotericin B deoxycholate; IDSA, Infectious Disease Society of America; IPA, invasive pulmonary aspergillosis.