Combined amphotericin and micofunging: evidence – pro

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Fungal infections in the setting of stem cell transplant inad GVHD are notoriously hard to treat. In some such situations, clinicians empirically combine more than one anti-fungal agents,  such as amphotericin and micofungin. In vitro and mouse studies suggest greater efficacy for amphotericin and micofungin combination and favorable pharamacokinetics, although human studies thus far have focused on comparative efficacies of these two agents. However, combination studies are beginning to be done. Such studies are active, for example, Study to Compare the Efficacy and Safety of Micafungin Versus Conventional Amphotericin B for the Treatment of Neonatal Candidiasis (MAGIC-2), CT00815516.

Dennis CG, Greco WR, Brun Y, Youn R, Slocum HK, Bernacki RJ, Lewis R, Wiederhold N, Holland SM, Petraitiene R, Walsh TJ, Segal BH.Effect of amphotericin B and micafungin combination on survival, histopathology, and fungal burden in experimental aspergillosis in the p47phox-/- mouse model of chronic granulomatous disease.Antimicrob Agents Chemother. 2006 Feb;50(2):422-7.

Yoji Nagasaki,et al, Combination therapy with micafungin and amphotericin B for invasive pulmonary aspergillosis in an immunocompromised mouse model J. Antimicrob. Chemother. first published online May 22, 2009 doi:10.1093/jac/dkp175

Nishi I, Sunada A, Toyokawa M, Asari S, Iwatani Y. Evaluation of amphotericin B and micafungin combination against clinical isolates of Aspergillus species. J Chemother. 2011 Apr;23(2):102-6.

Karl V. Clemons et al, Comparative Efficacies of Conventional Amphotericin B, Liposomal Amphotericin B (AmBisome), Caspofungin, Micafungin, and Voriconazole Alone and in Combination against Experimental Murine Central Nervous System Aspergillosis Antimicrob. Agents Chemother. December 2005 vol. 49 no. 12 4867-4875

 

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