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When to change treatment of acute invasive aspergillosis: an expert viewpoint
- Source :
- The Journal of antimicrobial chemotherapy, 77(1), 16-23. Oxford University Press, Repisalud, Instituto de Salud Carlos III (ISCIII), Journal of Antimicrobial Chemotherapy, The Journal of antimicrobial chemotherapy, vol 77, iss 1
- Publication Year :
- 2021
- Publisher :
- Oxford University Press, 2021.
-
Abstract
- Invasive aspergillosis (IA) is an acute infection affecting patients who are immunocompromised, as a result of receiving chemotherapy for malignancy, or immunosuppressant agents for transplantation or autoimmune disease. Whilst criteria exist to define the probability of infection for clinical trials, there is little evidence in the literature or clinical guidelines on when to change antifungal treatment in patients who are receiving prophylaxis or treatment for IA. To try and address this significant gap, an advisory board of experts was convened to develop criteria for the management of IA for use in designing clinical trials, which could also be used in clinical practice. For primary treatment failure, a change in antifungal therapy should be made: (i) when mycological susceptibility testing identifies an organism from a confirmed site of infection, which is resistant to the antifungal given for primary therapy, or a resistance mutation is identified by molecular testing; (ii) at, or after, 8 days of primary antifungal treatment if there is increasing serum galactomannan, or galactomannan positivity in serum, or bronchoalveolar lavage fluid when the antigen was previously undetectable, or there is sudden clinical deterioration, or a new clearly distinct site of infection is detected; and (iii) at, or after, 15 days of primary antifungal treatment if the patient is clinically stable but with ≥2 serum galactomannan measurements persistently elevated compared with baseline or increasing, or if the original lesions on CT or other imaging, show progression by >25% in size in the context of no apparent change in immune status. F2G Ltd funded the advisory board, provided travel and accommodation costs, as well as providing an honorarium according to global, national and local regulations for the time spent at the workshop and for completing the pre- and post-meeting questionnaires. None of the authors was paid for writing or reviewing this paper. Sí
- Subjects :
- AZOLE RESISTANCE
Antifungal Agents
EUROPEAN-ORGANIZATION
Aspergillosis
MYCOSES STUDY-GROUP
Mannans
chemistry.chemical_compound
Medicine
Pharmacology (medical)
Pharmacology & Pharmacy
MULTICENTER VALIDATION
Invasive Pulmonary Aspergillosis
AMPHOTERICIN-B
medicine.diagnostic_test
Pharmacology and Pharmaceutical Sciences
Resistance mutation
AcademicSubjects/MED00290
Infectious Diseases
Medical Microbiology
6.1 Pharmaceuticals
VORICONAZOLE
Infection
Bronchoalveolar Lavage Fluid
Life Sciences & Biomedicine
Microbiology (medical)
medicine.medical_specialty
Clinical Trials and Supportive Activities
Reviews
Context (language use)
Malignancy
Microbiology
Galactomannan
Immunocompromised Host
Rare Diseases
SDG 3 - Good Health and Well-being
Clinical Research
FUNGAL-INFECTIONS
Internal medicine
Humans
AcademicSubjects/MED00740
ACUTE-LEUKEMIA
Pharmacology
Science & Technology
FUMIGATUS
business.industry
ANTIFUNGAL THERAPY
Evaluation of treatments and therapeutic interventions
medicine.disease
Clinical trial
Transplantation
Editor's Choice
Bronchoalveolar lavage
chemistry
business
AcademicSubjects/MED00230
Invasive Fungal Infections
Subjects
Details
- Language :
- English
- ISSN :
- 03057453
- Database :
- OpenAIRE
- Journal :
- The Journal of antimicrobial chemotherapy, 77(1), 16-23. Oxford University Press, Repisalud, Instituto de Salud Carlos III (ISCIII), Journal of Antimicrobial Chemotherapy, The Journal of antimicrobial chemotherapy, vol 77, iss 1
- Accession number :
- edsair.doi.dedup.....01b586e3068c6ab0c187065e352b5520