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Cited by 43Antifungal resistance and susceptibilityFungal Infections and StudiesInfectious Diseases and Mycology

Antifungal combinations in Mucorales: A microbiological perspective

Schwarz, Patrick, Cornely, Oliver A., Dannaoui, Eric·2019·Mycoses
DOI 10.1111/myc.12909
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Abstract

Summary: Mucormycosis mostly affects immunocompromised patients and is associated with a high morbidity and mortality despite currently available treatments. In that context, combination therapy might be the key to a better outcome for these patients. Purpose of this review is to summarise and to discuss the current combination data obtained in vitro, in vivo in animal models of mucormycosis, and in patients. In vitro combination studies showed that most of the interactions between antifungal drugs were indifferent, even though that some synergistic interactions were achieved for the combination of echinocandins with either azoles or amphotericin B. Importantly, antagonism was never observed. Animal models of mucormycosis focused on infections caused by Rhizopus arrhizus, neglecting most other species responsible for human disease. In these experimental animal models, no strong interactions have been demonstrated, although a certain degree of synergism has been reported in some instances. Combinations of antifungals with non‐antifungal drugs have also been largely explored in vitro and in animal models and yielded interesting results. In patients with ketoacidosis and rhino‐orbito‐cerebral infection, combination of polyene with caspofungin was effective. In contrast, despite promising experimental data, adjunctive therapy with the iron chelator deferasirox was unfavourable and was associated with a higher mortality than monotherapy with liposomal amphotericin B. More combinations have to be tested in vitro and a much larger panel of Mucorales species has to be tested in vivo to give a valuable statement if antifungal combination therapy could be an effective treatment strategy in patients with mucormycosis.

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  • Mucorales species have baseline resistance to echinocandins, itraconazole, and voriconazole via alterations in LDM.

    “Mucorales species possess baseline resistance to echinocandins, itraconazole, and voriconazole via alterations in LDM.”

    From Investigational Agents for the Treatment of Resistant Yeasts and Molds (2021) · cites this paper as [16]

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Authors
Schwarz, P., Cornely, O. A., & Dannaoui, E.
Affiliations
  • Philipps University of Marburg (DE)
  • University of Cologne (DE)
  • Université Paris Descartes Faculté de Médecine AP‐HP Hôpital Européen Georges Pompidou Unité de Parasitologie‐Mycologie Paris France
Corresponding author
Schwarz, Patrick
ORCID
Venue
Mycoses
Publisher
Wiley
Published
2019-07-19
Volume
62
Issue
9
Pages
746-760
ISSN
  • 0027-5557 (ISSN-L)
  • 0933-7407
  • 1439-0507
DOI
10.1111/myc.12909
OpenAlex
W2918510489
Cited by
43
References
132
Citations by year
2026: 3 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 13 · 2021: 5 · 2020: 7 · 2019: 1
FWCI
0.90
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Mycoses (publishedVersion)
  • PubMed (publishedVersion)
  • Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
  • HAL (submittedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
  • Health Sciences › Veterinary › Small Animals › Infectious Diseases and Mycology
Keywords
mucormycosis, Mucorales, combination antifungal therapy, echinocandins, azoles, amphotericin B, caspofungin, Rhizopus oryzae, drug synergy, drug antagonism, deferasirox, liposomal amphotericin B, rhinocerebral mucormycosis, ketoacidosis, immunocompromised patients
MeSH terms
Amphotericin B, Animals, Antifungal Agents, Azoles, Disease Models, Animal, Drug Synergism, Drug Therapy, Combination, Humans, Microbial Sensitivity Tests, Mucorales, Mucormycosis, Immunocompromised Host, Mice, Lipopeptides

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