Información del artículo
El tratamiento antifúngico combinado, simultáneo o secuencial, se ha considerado, con frecuencia, como una alternativa adecuada para mejorar los resultados que se obtienen con la monoterapia. Las equinocandinas, grupo de fármacos al que pertenece la anidulafungina, poseen un mecanismo de acción diferente del de los demás fármacos antifúngicos, lo que aventura cuando menos buenas posibilidades de sinergia con otros grupos. Sin embargo, la mayoría de los datos disponibles sobre la eficacia de las diferentes combinaciones procede de modelos de infección en animales, datos in vitro y comunicación de casos clínicos, mientras son muy escasos los datos procedentes de ensayos clínicos controlados. Los datos disponibles no permiten afirmar que el tratamiento combinado tenga una eficacia significativamente superior a la de la monoterapia; sin embargo, puede ser adecuado para el tratamiento de micosis invasoras graves asociadas a una elevada tasa de mortalidad, tales como las formas de aspergilosis que cursan con afección del sistema nervioso central o afección pulmonar extensa, cavitada o con insuficiencia respiratoria, y las infecciones causadas por hongos multirresistentes.
Palabras clave:
Anidulafungina
Tratamiento combinado
Equinocandina
Combined, simultaneous or sequential antifungal therapy has often been considered an appropriate option to improve the results obtained with monotherapy. Anidulafungin belongs to the echinocandin family, which has a different mechanism of action from the remaining antifungal agents, a characteristic that heralds a good chance of synergy with other groups. However, most of the data available on the efficacy of different combinations comes from animal models of infection, «in vitro» data and case reports, while data from controlled clinical trials are scarce. The available data are insufficient to allow us to conclude that the efficacy of combined therapy is significantly superior to that of monotherapy. However, the efficacy of combined therapy may be adequate for the treatment of severe invasive mycoses associated with high mortality rates, such as forms of aspergillosis that provoke central nervous system involvement, extensive pulmonary involvement, cavitated areas, or respiratory failure and infections caused by multiresistant fungi.
Key words:
Anidulafungin
Combined therapy
Echinocandin
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