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Guidelines for the use of antifungal agents in the treatment of invasive Candida and mould infections

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Treatment of invasive fungal infections is increasingly complex. Amphotericin B deoxycholate has long been the mainstay of treatment. However, there has been increasing recognition of both the propensity for nephro¬≠toxicity in haematology, transplant and intensive care patients as well as its adverse impact on morbidity and mortality. This has coincided with the availabilty of newer, and in certain settings, more effective antifungal agents. Although the newer agents clearly cause less nephrotoxicity than amphotericin B, drug interactions, hepatic effects and unique side-effects need to be considered. The spectrum of the newer triazoles and echino¬≠candins varies, highlighting the importance of accurate identification of the causative organism where possible. Consensus Australian guidelines have been developed to assist clinicians with treatment choices by reviewing the current evidence for the efficacy, the toxicity and the cost of these agents. (Intern Med J 2004; 34: 192−200)
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Keywords: Aspergillus; Candida; antifungal therapy; moulds

Document Type: Research Article

Affiliations: 1: Department of Clinical Haematology and Medical Oncology, Royal Melbourne Hospital, 2: Department of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, 3: Victorian Infectious Diseases Service, Centre for Clinical Research Excellence in Infectious Diseases and 4: Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, and 5: Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, 6: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia

Publication date: April 1, 2004

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