Combination antifungal therapy for invasive aspergillosis – Is it indicated?

The optimal therapy for invasive aspergillosis (IA) is unknown, and there is little agreement on the exact antifungal management of IA. The previously stagnant landscape of antifungal choices for IA is rapidly changing with newer antifungals and newer targets. While amphotericin B had historically been the preferred therapy, recent studies support voriconazole as primary therapy or caspofungin as salvage therapy. However, in vitro studies, animal models, and limited clinical reports suggest that combination antifungal therapy might offer improved outcome. While treatment of malignancy or HIV has advanced after years of clinical trials investigating optimal combinations, therapy for IA is comparatively decades behind. Until very recently, combination antifungal therapy for IA was of little consequence since there were a limited number of possible permutations available. There have been a great deal of new data published exploring the possibilities of combination therapy, but clinicians need to be aware of the potential advantages and disadvantages of combination antifungal therapy for IA as well as the difficulties in interpreting the available data.