Associations antifongiques dans les infections fongiques invasives
Les mycoses invasives (candidoses, aspergilloses et cryptococcoses) sont des complications infectieuses fréquentes d’une immunodépression, responsables d’une importante morbimortalité. Leur traitement de première ligne bénéficie de recommandations thérapeutiques qui sont basées selon les pathologies...
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Published in | La revue de medecine interne Vol. 31; no. 1; pp. 72 - 81 |
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Main Authors | , , , |
Format | Journal Article |
Language | French |
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Paris
Elsevier SAS
2010
Elsevier |
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Abstract | Les mycoses invasives (candidoses, aspergilloses et cryptococcoses) sont des complications infectieuses fréquentes d’une immunodépression, responsables d’une importante morbimortalité. Leur traitement de première ligne bénéficie de recommandations thérapeutiques qui sont basées selon les pathologies sur des essais randomisées ou sur des avis d’experts, et sont constituées essentiellement de monothérapies antifongiques, sauf pour la cryptococcose. Mais la sévérité de ces infections et l’existence de nombreux travaux expérimentaux et cliniques sur le sujet soulèvent la question de l’apport des bithérapies antifongiques, en traitement d’attaque ou de seconde ligne. Dans la cryptococcose neuroméningée, l’association amphotéricine B plus flucytosine a été bien validée dans des études randomisées, notamment chez les patients séropositifs pour le VIH. Dans les candidémies, des études démontrent l’absence d’antagonisme de l’association fluconazole plus amphotéricine B. Dans l’aspergillose, de rares études cliniques suggèrent, malgré des limites méthodologiques, un bénéfice des associations caspofungine plus polyène ou caspofungine plus azolé. Mais des études randomisées sont encore nécessaires pour démontrer le bénéfice de ces dernières associations. Une étude évaluant l’association anidulafungine plus voriconazole dans le traitement des aspergilloses invasives devrait débuter prochainement.
Invasive fungal infections (candidiasis, aspergillosis and cryptococcosis) are major complications in immunocompromised patients and account for high morbidity and mortality. Guidelines on first-line therapy of invasive fungal infections are based on randomised clinical trials or experts’ guidelines and include essentially single antifungal therapies, except for cryptococcosis. However, the severe prognosis of these infections raises the interest of antifungal associations, in first line or second-line therapy, and many experimental data have been published on this issue. In humans, amphotericin B plus flucytosine combination therapy in cryptococcal meningitis has been largely validated, especially in HIV-infected patients. Also, a few studies demonstrated that the combination of fluconazole plus amphotericin B in candidiasis is not antagonistic and that caspofungin plus polyene or caspofungin plus azole combinations may be beneficial in invasive aspergillosis. Randomised studies are necessary to confirm these data. A study assessing anidulafungin plus voriconazole association in aspergillosis is oncoming. |
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AbstractList | Les mycoses invasives (candidoses, aspergilloses et cryptococcoses) sont des complications infectieuses fréquentes d’une immunodépression, responsables d’une importante morbimortalité. Leur traitement de première ligne bénéficie de recommandations thérapeutiques qui sont basées selon les pathologies sur des essais randomisées ou sur des avis d’experts, et sont constituées essentiellement de monothérapies antifongiques, sauf pour la cryptococcose. Mais la sévérité de ces infections et l’existence de nombreux travaux expérimentaux et cliniques sur le sujet soulèvent la question de l’apport des bithérapies antifongiques, en traitement d’attaque ou de seconde ligne. Dans la cryptococcose neuroméningée, l’association amphotéricine B plus flucytosine a été bien validée dans des études randomisées, notamment chez les patients séropositifs pour le VIH. Dans les candidémies, des études démontrent l’absence d’antagonisme de l’association fluconazole plus amphotéricine B. Dans l’aspergillose, de rares études cliniques suggèrent, malgré des limites méthodologiques, un bénéfice des associations caspofungine plus polyène ou caspofungine plus azolé. Mais des études randomisées sont encore nécessaires pour démontrer le bénéfice de ces dernières associations. Une étude évaluant l’association anidulafungine plus voriconazole dans le traitement des aspergilloses invasives devrait débuter prochainement.
Invasive fungal infections (candidiasis, aspergillosis and cryptococcosis) are major complications in immunocompromised patients and account for high morbidity and mortality. Guidelines on first-line therapy of invasive fungal infections are based on randomised clinical trials or experts’ guidelines and include essentially single antifungal therapies, except for cryptococcosis. However, the severe prognosis of these infections raises the interest of antifungal associations, in first line or second-line therapy, and many experimental data have been published on this issue. In humans, amphotericin B plus flucytosine combination therapy in cryptococcal meningitis has been largely validated, especially in HIV-infected patients. Also, a few studies demonstrated that the combination of fluconazole plus amphotericin B in candidiasis is not antagonistic and that caspofungin plus polyene or caspofungin plus azole combinations may be beneficial in invasive aspergillosis. Randomised studies are necessary to confirm these data. A study assessing anidulafungin plus voriconazole association in aspergillosis is oncoming. Invasive fungal infections (candidiasis, aspergillosis and cryptococcosis) are major complications in immunocompromised patients and account for high morbidity and mortality. Guidelines on first-line therapy of invasive fungal infections are based on randomised clinical trials or experts’ guidelines and include essentially single antifungal therapies, except for cryptococcosis. However, the severe prognosis of these infections raises the interest of antifungal associations, in first line or second-line therapy, and many experimental data have been published on this issue. In humans, amphotericin B plus flucytosine combination therapy in cryptococcal meningitis has been largely validated, especially in HIV-infected patients. Also, a few studies demonstrated that the combination of fluconazole plus amphotericin B in candidiasis is not antagonistic and that caspofungin plus polyene or caspofungin plus azole combinations may be beneficial in invasive aspergillosis. Randomised studies are necessary to confirm these data. A study assessing anidulafungin plus voriconazole association in aspergillosis is oncoming. Les mycoses invasives (candidoses, aspergilloses et cryptococcoses) sont des complications infectieuses fréquentes d’une immunodépression, responsables d’une importante morbimortalité. Leur traitement de première ligne bénéficie de recommandations thérapeutiques qui sont basées selon les pathologies sur des essais randomisées ou sur des avis d’experts, et sont constituées essentiellement de monothérapies antifongiques, sauf pour la cryptococcose. Mais la sévérité de ces infections et l’existence de nombreux travaux expérimentaux et cliniques sur le sujet soulèvent la question de l’apport des bithérapies antifongiques, en traitement d’attaque ou de seconde ligne. Dans la cryptococcose neuroméningée, l’association amphotéricine B plus flucytosine a été bien validée dans des études randomisées, notamment chez les patients séropositifs pour le VIH. Dans les candidémies, des études démontrent l’absence d’antagonisme de l’association fluconazole plus amphotéricine B. Dans l’aspergillose, de rares études cliniques suggèrent, malgré des limites méthodologiques, un bénéfice des associations caspofungine plus polyène ou caspofungine plus azolé. Mais des études randomisées sont encore nécessaires pour démontrer le bénéfice de ces dernières associations. Une étude évaluant l’association anidulafungine plus voriconazole dans le traitement des aspergilloses invasives devrait débuter prochainement. |
Author | Dannaoui, E. Gellen-Dautremer, J. Lortholary, O. Lanternier, F. |
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Keywords | Antifungal combination therapy Aspergillose Cryptococcosis Aspergillosis Associations antifongiques Candidemia Cryptococcose Candidémie Infection Association médicamenteuse Traitement associé Mycose Antifongique Forme invasive |
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Snippet | Les mycoses invasives (candidoses, aspergilloses et cryptococcoses) sont des complications infectieuses fréquentes d’une immunodépression, responsables d’une... Invasive fungal infections (candidiasis, aspergillosis and cryptococcosis) are major complications in immunocompromised patients and account for high morbidity... |
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SubjectTerms | Antifungal combination therapy Aspergillose Aspergillosis Associations antifongiques Candidemia Candidémie Cryptococcose Cryptococcosis Generalites Life Sciences Mycoses Mycoses diverses Mycoses humaines Pathologie infectieuse Sciences biologiques et medicales Sciences medicales |
Title | Associations antifongiques dans les infections fongiques invasives |
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