antibioticsbooks

chapter 26 Antifungal Drugs 169
fungal disease often presents no differently than
bacterial disease, but the pathogens can be more difficult
to isolate on culture. This makes the prompt
initiation of empiric therapy important when invasive
fungal infections are suspected. Prophylaxis is
also used in highly susceptible popula tions to prevent
fungal infections from developing.
Another concern in the treatment of fungal disease
is that most centers do not conduct antifungal
susceptibility testing. This forces clinicians to
guess at likely susceptibility patterns based on speciation
rather than test results. Further, the capabilities
of the host significantly affect the likelihood
of success in treating an invasive fungal infection.
For neutropenic patients with mycoses, neutrophil
recovery is a significant predictor of success, and
patients with a prolonged immunocompromised
status have a much worse prognosis. Therefore,
while the selection of an appropriate antifungal is
important, control of patient risk factors for fungal
infection is perhaps more so, whether it is the need
to remove a central venous catheter or to decrease
doses of immunosuppressants.
Compared with the abundance of drugs available
to kill bacteria, the number of systemic antifungal
drugs is much lower. Selective toxicity is
more difficult to achieve with eukaryotic fungi than
with prokaryotic bacteria. Several newly marketed
agents have changed the way fungal infections are
treated. The chapters that follow introduce these
agents in more detail.