New Treatment Strategies in Patients

High doses of deoxycholate amphotericin B associated with surgery was considered until recently the treatment of choice for zygomycosis (Dromer & McGinnis, 2002) but was associated with a high rate of nephrotoxicity. Development of the lipid formulations of amphotericin B, which cause less nephrotoxicity, allowed for administration of higher dosages. Although there have been no prospective trials to compare efficacy of deoxycholate amphotericin B with lipid formulations, there is a consensus that a lipid formulation of amphotericin B represents the best treatment for zygomycosis (Spellberg et al., 2005a; Chayakulkeeree et al., 2006). Case series and retrospective studies have shown favorable outcomes in patients treated with either amphotericin B colloidal dispersion (Herbrecht et al., 2001), amphotericin B lipid complex (Walsh et al., 1998), or liposomal amphotericin B (Gleissner et al., 2004). The relative efficacy of the different lipid formulations remains unknown. Nevertheless, based on pharmacokinetic data and results obtained in experimental models, iiposomal amphotericin B at 10 mg/kg/day, in combination with surgery, has been proposed as the first-line therapy of zygomycosis (Spellberg et al., 2005a).

Among other antifungals, posaconazole is the only drug that has been used in a reasonable number of patients. The first case of successful treatment of zygomyco-sis with posaconazole has been reported in 2003 (Tobon et al., 2003) and several other individual case reports have been published afterward. The analysis of outcome in the first 24 patients who received posaconazole as salvage therapy for zygomycosis (as a second-line therapy after failure of or intolerance to amphotericin B) showed promising results with an overall surviving rate of 79% (Greenberg et al., 2006). These results have been confirmed in the retrospective analysis of 91 patients treated with posaconazole for zygomycosis refractory to or intolerant of prior antifungal therapy (van Burik et al., 2006). Nevertheless, posaconazole is not currently approved for treatment of zygomycosis and its role in the management of zygomycosis remains to be further evaluated in prospective studies.

Combination treatment has been rarely used in patients with zygomycosis until now (Voitl et al., 2002; Vazquez et al., 2005; Nivoix et al., 2006; Rickerts et al., 2006a). It is therefore difficult to draw any conclusion. In one case of rhinocerebral zygomycosis in a neutropenic patient (Vazquez et al., 2005) a combination of lipo-somal amphotericin B with caspofungin was successfully used. In contrast, the same combination was not effective in two other reported cases (Nivoix et al., 2006; Voitl et al., 2002). Combination of liposomal amphotericin B with posaconazole has been reported to be effective in treating one patient (Rickerts et al., 2006a).

Despite antifungal therapy, mortality rate in zygomycosis remains very high and there is a need for new therapeutic strategies. Iron chelation could be one of these strategies. Very recently, deferasirox, an iron chelator approved for treatment of iron overload has been successfully used as salvage therapy in a patient with rhi-nocerebral zygomycosis (Reed et al., 2006).

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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