Which of the following antifungals is are drugs of choice for the treatment of invasive aspergillosis invasive candidiasis and candidemia?

Azole Resistance Develops in the Body and in the Environment

We know of two ways that A. fumigatus can develop resistance to azoles.

1. Inside the body: Strains of A. fumigatus in people who take azole antifungals for a long period of time can become resistant, survive treatment, and continue to cause infection.
2. Outside the body: Strains of A. fumigatus on decaying plants in the environment can be exposed to azole compounds used as fungicides that are chemically-similar to azole antifungal medications. These strains can develop resistance to azoles. 8-11

Azole Fungicide Use

Azole fungicides are used throughout the world to treat plant infections, prevent crop loss, and increase production. Patients with azole-resistant aspergillosis have been infected with A. fumigatus strains with the same resistance gene markers (TR34/L98H and TR46/Y121F/T289A) as resistant strains found in the environment associated with agricultural azole fungicide use.3, 14 Resistant Aspergillus infections are also found in people who have not taken azole antifungals, further suggesting that the resistance is partially driven by environmental sources.12 While this is becoming common in Europe, so far only a small number of cases have been identified in the United States.

Estimates from the United States Geological Survey show that agricultural azole fungicide use quadrupled (434%) in the United States from 2013-2016.13 A direct association between the quantity of U.S. agricultural azole fungicide use and human infections has not been established.

CDC is working with partners to assess the potential impact of increased fungicide use in the United States on the development of azole-resistance and establishing initiatives to help protect public health while maintaining healthy and stable crop production.

Preventing Azole Resistance

Any use of antifungals can contribute to the development of antifungal resistance. Ensuring appropriate use of azoles in human medicine, agriculture, and industry will be essential to curbing the spread of antifungal resistance. In clinical settings, healthcare providers can adopt antifungal stewardship practices and order susceptibility testing when aspergillosis is suspected. In serious cases where testing is not readily available, healthcare providers should consult their state or local health department. The agricultural community, phytologists, and federal partners should work together to consider alternative ways to protect and treat crops. Integrated pest management (IPM) is one strategy that has been recognized internationally by the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) to successfully reduce the need for pesticide use and improve food quality and crop yields.

What CDC is doing

CDC is working with the Environmental Protection Agency, the U.S. Department of Agriculture, and other agencies to address issues surrounding the environment and antimicrobial resistance.

CDC is leading and supporting several projects through the AR Solutions Initiative including:

• Expanding resistance testing for A. fumigatus clinical isolates through the AR Lab Network.
• Supporting the University of California (UCLA) in a two-year project establishing a facility-level surveillance system for influenza-associated Aspergillus infections
• Working with the Mycoses Study Group and several U.S. medical centers to identify COVID-19-associated pulmonary aspergillosis and other secondary fungal infections.
• Supporting a University of Georgia project testing environmental samples from agricultural sites in different regions of the United States to better assess the presence of triazole-resistant A. fumigatus in the environment

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Which of the following antifungals is are drug's of choice for the treatment of invasive aspergillosis invasive candidiasis and candidemia?

What is the best treatment for invasive candidiasis?

Which antifungal drug is often the drug of choice to treat a disseminated or invasive fungal infection in an immunocompromised patient?

Which drug is the drug of choice in candidiasis?