Clinical Outcomes of combination antimicrobial therapy in Patients with fungal pathogenesis

Kavita Reddy; A. Kapoor; N. Kapoor

doi:10.5281/zenodo.22812886

Authors

Kavita Reddy Division of Clinical Bacteriology, Seine Research Center for Medical Microbiology Author https://orcid.org/8353-7367-8636-455X
A. Kapoor Division of Clinical Bacteriology, Indus Academy of Medical Microbiology Author https://orcid.org/7728-9890-2770-1375
N. Kapoor Department of Medical Microbiology, Oder Institute for Advanced Medical Microbiology Author https://orcid.org/3429-7556-3153-0968

DOI:

https://doi.org/10.5281/zenodo.22812886

Keywords:

combination antifungal therapy, cryptococcal meningitis, invasive aspergillosis, candidemia, antifungal stewardship

Abstract

Graphical abstract

Background: Combination antimicrobial therapy, pairing agents from different antifungal classes, has long been proposed to improve survival over monotherapy in invasive fungal disease, but the strength of that evidence differs sharply across pathogens.

Objective: To synthesize published clinical-outcomes evidence on combination antifungal therapy for cryptococcal meningitis, invasive mould disease, and candidemia.

Methods: We synthesized randomized trials, prospective cohorts and society guidelines reporting mortality or mycological clearance for combination versus monotherapy antifungal regimens in adults with confirmed fungal infection.

Results: Amphotericin B plus flucytosine reduced two-week mortality in cryptococcal meningitis to roughly 8-11%, against approximately 25% with monotherapy; voriconazole-echinocandin combinations showed only subgroup-limited benefit in aspergillosis; polyene-echinocandin combinations improved survival in mucormycosis cohorts; and monotherapy performed adequately in candidemia.

Conclusions: Combination therapy improves outcomes in fungal pathogenesis in a syndrome-specific rather than uniform manner, and stewardship should match combination intensity to each syndrome's evidence base.

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