Abstract
Purpose of Review
Patients on antifungal therapy who develop breakthrough mold infections pose significant treatment challenges for clinicians. Treatment of these infections demands a multimodal approach, including a thorough patient assessment, immune restoration, and evaluation for nonadherence and drug–drug interactions. However, limited clinical trial data are available to guide therapeutic decision-making.
Recent Findings
Organisms associated with breakthrough mold infection have historically included
Aspergillus
species and the Mucorales; however, rare and resistant molds are increasing in prevalence. Treatment failure and mortality rates remain high with breakthrough infection, irrespective of the selected treatment. Therapeutic drug monitoring, dose optimization, and combination antifungal therapy have been increasingly used to treat refractory cases.
Summary
Switch therapy and combination antifungal therapy represent the major treatment strategies for breakthrough mold infection. Herein, preclinical and clinical data are reviewed supporting the merits of each approach. Additionally, recommendations for therapeutic drug monitoring are provided.