Liposomal amphotericin B-the present

Recent research frontiers of heterocycles as antifungal Agents: Insights from the past five years

This review explores the growing global concern of fungal infections, particularly in immunocompromised individuals, and highlights the critical need for improved antifungal therapies. With the rise of multidrug-resistant strains, such as Candida auris and Aspergillus fumigatus, current antifungal treatments face limitations, including toxicity, low bioavailability, and the development of resistance. Heterocyclic compounds, particularly those targeting key fungal enzymes and pathways, are emerging as promising candidates in the fight against these infections. The review focuses on the structural diversity and mechanisms of action of heterocyclic antifungal agents, including azoles, echinocandins, novel dual-target inhibitors, and more. Additionally, it discusses advancements in drug design, delivery systems, and the role of artificial intelligence in identifying new compounds. By addressing gaps in existing therapies and presenting new insights into heterocyclic drug development, this study aims to guide future research towards more effective and safer antifungal treatments.

Advancing fungal keratitis treatment: transitioning from conventional amphotericin B therapy to nanocarrier-based delivery systems

Fungal keratitis (FK) is a serious, vision-threatening ocular infection caused by various fungal species. Poor outcomes often leave patients with corneal opacification and loss of vision, occasionally advancing to enucleation due to the lack of effective treatment options. Several health agencies have outlined topical antifungal medications as first-line approaches in treating FK. Commercially available topical antifungal formulations are natamycin (5%), voriconazole (1%), fluconazole (0.2-0.5%), itraconazole (1%), and amphotericin B (0.15%). Different molecules remain effective against various species of fungus. However, amphotericin B (Am-B) is a broad-spectrum antifungal agent, and when all other medications fail, Am-B is the only drug of choice. However, its clinical application is hindered due to the non-availability of ophthalmic marketed products because of its poor pharmaco-technical factors (low solubility, poor permeation, unstable in solutions of pH 3-10, etc.). Therefore, clinicians are forced to use Am-B injectables off-label by preparing the diluted concentrations of Am-B for ophthalmic use. These solutions have limitations, viz., poor stability, rapid precorneal clearance, and limited drug retention. Thus, it is highly essential for the development of advanced ophthalmic novel drug delivery systems so that the therapeutic and toxic profiles of drugs might improve. Therefore, the present review explores the limitations of conventional Am-B therapy and highlights the transformative potential of nanocarrier-based delivery systems in FK management. It discusses various nanocarrier strategies, their pharmacokinetics, and preclinical and clinical advancements. By bridging the gap between conventional treatments and modern nanotechnology, this review underscores the potential of nanocarriers to revolutionize FK treatment, offering more effective and patient-friendly therapeutic solutions.

In vitro activity of SF001: a next-generation polyene versus amphotericin B

SF001, a next-generation polyene drug, offers broad-spectrum fungicidal activity with less potential for toxicity than classic polyene amphotericin B (AmB). This study compared the in vitro activity of SF001 and amphotericin B against Candida and Aspergillus species. SF001 demonstrated activity comparable to AmB against Candida isolates (MIC50/90 of 0.25/1 and 0.5/0.5 mg/L, respectively). However, Aspergillus isolates exhibited higher susceptibility to SF001 than AmB (MIC50/90 of 0.5/1 and 1/4 mg/L, respectively), notably including AmB-resistant species.

Successful Primary Oral Isavuconazole Therapy in Acute Invasive Fungal Sinusitis with Triple Fungal Species and Multiple Comorbidities

Reporting the first successful treatment with oral Isavuconazole as primary antifungal agent following debridement, in an immunocompromised adult male with acute invasive fungal sinusitis involving multiple simultaneous fungal species. His comorbidities were retroviral and COVID infections, uncontrolled diabetes, ketoacidosis, and renal failure. A two-year follow-up revealed no recurrence.

Antifungal-drug interactions in oncology: A cross-sectional study highlighting the role of pharmacists

STUDY OBJECTIVE

Complex pharmacotherapy in cancer patients increases the likelihood of drug-drug interactions (DDIs). Pharmacists play a critical role in the identification and management of DDIs. The aim of present study was to evaluate the role of pharmacist in identifying antifungal drug interactions in cancer patients and providing relevant recommendations.

METHODOLOGY

A retrospective, cross-sectional study was conducted to identify antifungal drug interactions over the period of 5 years (2019-2023) among cancer patients. Electronic medical record of 384 hospitalized patients receiving systemic antifungal therapy were reviewed. Severity of interactions and risk classification were made using UptoDate® LexidrugTM software. Pharmacists' recommendations regarding DDIs were also documented. Descriptive statistics and logistic regression were applied to interpret results.

RESULTS

Antifungals were more frequently prescribed to adult patients (53.9%). Female cancer patients were significantly more likely to encounter DDIs than males (p < 0.003). Type of cancer and fungal infections were significantly associated with incidence of DDIs (p < 0.01; p = 0.000). Pharmacist identified DDIs in 53.9% antifungal prescriptions with 22.2% classified as major interactions. A substantial proportion of these interactions involved voriconazole (40.1%). Majority of pharmacist's recommendations included dose optimization of voriconazole (10.4%), close monitoring of RFTs (8.9%) and withholding amphotericin (5.2%) during chemotherapy. All of the recommendations made by pharmacists were accepted by physicians (100%).

CONCLUSION

The findings indicate that pharmacists identified DDIs in 53.9% of prescriptions and all of their recommendations were accepted by physicians. This highlights the critical role of pharmacists in detecting potential interactions, ensuring medication safety, and minimizing adverse effects associated with complex pharmacotherapy.

The evolution of antifungal therapy: Traditional agents, current challenges and future perspectives

Fungal infections kill more than 3 million people every year. This high number reflects the significant challenges that treating these diseases worldwide presents. The current arsenal of antifungal drugs is limited and often accompanied by high toxicity to patients, elevated treatment costs, increased frequency of resistance rates, and the emergence of naturally resistant species. These treatment challenges highlight the urgency of developing new antifungal therapies, which could positively impact millions of lives each year globally. Our review offers an overview of the antifungal drugs currently available for treatment, presents the status of new antifungal drugs under clinical study, and explores ahead to future candidates that aim to help address this important global health issue.

Progress in antileishmanial drugs: Mechanisms, challenges, and prospects

Leishmaniasis, a neglected tropical disease caused by Leishmania parasites, continues to pose global health challenges. Current treatments face issues like resistance, safety, efficacy, and cost. This review covers the discovery, mechanisms of action, clinical applications, and limitations of key antileishmanial agents: pentavalent antimonials, amphotericin B, miltefosine, paromomycin, and pentamidine. Despite toxicity and resistance (antimonials), hospitalization needs and side effects (amphotericin B), regional efficacy variability (miltefosine), inconsistent outcomes (paromomycin), and severe side effects (pentamidine), these drugs are vital. Novel strategies to overcome the deficiencies of current therapies are highlighted, including combination regimens, advanced drug delivery systems, and immunomodulatory approaches. Comprehensive and cooperative efforts are crucial to fully realize the potential of advancements in antileishmanial pharmacotherapy and to reduce the unacceptable worldwide burden imposed by this neglected disease.

Mono-N-alkylation of Amphotericin B and Nystatin A1 and Its Amides: Effect on the In Vitro Activity, Cytotoxicity and Permeabilization of Model Membranes

Objectives: In 2022, the World Health Organization highlighted the necessity for the development of new antifungal agents. Polyene antibiotics are characterized by a low risk of drug resistance; however, their use is limited by low solubility and severe side effects. Methods: A series of N-alkylated derivatives of amphotericin B and nystatin A1 as well as their N-(2-hydroxyethyl)amides were synthesized. Their antifungal activity was evaluated against various Candida strains and Aspergillus fumigatus using the broth microdilution method. Cytotoxicity was assessed using an MTT assay on human embryonic kidney cells HEK293 and human skin fibroblast cells hFB-hTERT6, as well as a hemolysis assay on erythrocytes. Membrane activity was analyzed by fluorimetric measurement of calcein leakage from model liposomes. Results: Derivatives containing the N-(hydroxyethyl)amino)ethyl fragment (compounds 3 and 4) exhibited relatively high antifungal activity, as did N-(2-hydroxyethyl)amides 5 and 9. Bis-modified compounds 6 and 10 did not outperform their mono-modified analogues in terms of activity or cytotoxicity. The mono-N-alkylated compound 3 showed the highest activity/toxicity ratio, which correlated well with its selectivity for ergosterol-containing model membranes. Discussion: Combining two successful modifications does not necessarily improve the activity/toxicity ratio of polyenes. Further studies can be performed for the optimization of carboxyl group of 3.

Application of Physiologically Based Pharmacokinetic Model to Compare the Biodistribution of Liposomal Amphotericin B With Conventional Amphotericin B Deoxycholate in Humans

Amphotericin B (AmB) has been a cornerstone in the treatment of invasive fungal infections for over 6 decades. Compared with conventional amphotericin B deoxycholate (AmB-DOC), liposomal amphotericin B has comparable efficacy but less nephrotoxicity. The main purpose of this study was to investigate the reason why liposomal amphotericin B has similar therapeutic effects but lower toxicity and the differences of distribution in humans between liposomal amphotericin B and AmB-DOC. To compare the distribution of liposomal amphotericin B and AmB-DOC in humans, the physiologically based pharmacokinetic (PBPK) model was established by bottom-up stepwise method. A rat PBPK model was established firstly, then verified in mouse level in consideration of interspecies differences in physiological- and drug-specific parameters, and finally the PBPK model was extrapolated to humans. Based on preclinical and clinical pharmacokinetic (PK) studies, the AmB-DOC and liposomal amphotericin B PBPK model were established, respectively. The simulated results of human PBPK model showed that the liposomal formulation changed the pharmacokinetic characteristics of AmB. Compared with AmB-DOC, the plasma exposure of liposomal formulation was higher, but the renal exposure was significantly reduced.

Complete central airway obstruction from aggressive mucormycosis in a patient with acute myeloid leukaemia

A woman in her 30s with type 2 diabetes and morbid obesity presented with flu-like symptoms, persistent cough and mild dyspnoea, unresponsive to pneumonia treatment. Diagnosed with acute myeloid leukaemia, she was started on induction chemotherapy. Despite prophylactic antifungal and antibacterial therapy, she developed a fever, a right upper lobe opacity and a complete airway obstruction by a large endobronchial mass in the right main stem. Bronchoscopy with biopsy and PCR confirmed mucormycosis. Although a combined antifungal regimen was started promptly, her condition worsened, leading to acute respiratory distress syndrome, tracheo-pleural fistulas and extensive necrotic mucosa in the airways. Surgical intervention was not feasible, and she was transitioned to hospice. Complete central airway obstruction and trachea-pleural fistula are rare manifestations of pulmonary mucormycosis. We conduct a literature review of endobronchial mucormycosis to highlight the importance of early recognition and a multimodal treatment approach to improve outcomes.

Improving antifungal lipid-based drug delivery against Candida: a review

INTRODUCTION

Fungal infections, particularly those caused by Candida spp. have increased in recent years. A primary contributor to this surge was the COVID-19 pandemic, where many hospitalized patients had secondary fungal infections. Additionally, the emergence of resistant and multi-resistant fungal strains has become increasingly problematic due to the limited therapeutic options available in antifungal treatments.

AREAS COVERED

This review presents a comprehensive analysis of recent studies focused on the development and characterization of lipid-based nanosystems as an emerging and promising therapeutic alternative. These systems have been evaluated for their potential to deliver antifungal agents specifically targeting resistant Candida spp. strains, offering a controlled and sustained release of drugs.

EXPERT OPINION

Lipid-based nanomaterials are promising tools for the controlled and sustained release of drugs, particularly in treating Candida spp. infections. Although substantial research has been dedicated to development of these nanomaterials, only a few have reached clinical application, such as liposomal amphotericin B, for example. Therefore, it is critical to push forward with advancements to bring these nanomedicines into clinical practice, where they can contribute meaningfully to mitigating the challenge of resistant and lethal fungal strains.

Nanomedicines as a cutting-edge solution to combat antimicrobial resistance

Antimicrobial resistance (AMR) poses a critical threat to global public health, necessitating the development of novel strategies. AMR occurs when bacteria, viruses, fungi, and parasites evolve to resist antimicrobial drugs, making infections difficult to treat and increasing the risk of disease spread, severe illness, and death. Over 70% of infection-causing microorganisms are estimated to be resistant to one or several antimicrobial drugs. AMR mechanisms include efflux pumps, target modifications (e.g., mutations in penicillin-binding proteins (PBPs), ribosomal subunits, or DNA gyrase), drug hydrolysis by enzymes (e.g., β-lactamase), and membrane alterations that reduce the antibiotic's binding affinity and entry. Microbes also resist antimicrobials through peptidoglycan precursor modification, ribosomal subunit methylation, and alterations in metabolic enzymes. Rapid development of new strategies is essential to curb the spread of AMR and microbial infections. Nanomedicines, with their small size and unique physicochemical properties, offer a promising solution by overcoming drug resistance mechanisms such as reduced drug uptake, increased efflux, biofilm formation, and intracellular bacterial persistence. They enhance the therapeutic efficacy of antimicrobial agents, reduce toxicity, and tackle microbial resistance effectively. Various nanomaterials, including polymeric-based, lipid-based, metal nanoparticles, carbohydrate-derived, nucleic acid-based, and hydrogels, provide efficient solutions for AMR. This review addresses the epidemiology of microbial resistance, outlines key resistance mechanisms, and explores how nanomedicines overcome these barriers. In conclusion, nanomaterials represent a versatile and powerful approach to combating the current antimicrobial crisis.

Functional Biomaterials and Biomaterial Composites with Antimicrobial Properties

AMR occurs when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial medicines, including antibiotics, antivirals, antifungals, and antiparasitics [...].

Paving the way for affordable and equitable liposomal amphotericin B access worldwide

Amphotericin B has long been crucial for treating many serious infectious diseases, such as invasive fungal infections and visceral leishmaniasis, particularly for patients who are immunocompromised, including those with advanced HIV infection. The conventional amphotericin B deoxycholate formulation has largely been replaced in high-income countries with liposomal amphotericin B (LAmB), which has many advantages, including lower rates of adverse events, such as nephrotoxicity and anaemia. Despite an evident need for LAmB in low-income and middle-income countries, where mortality from invasive fungal infections is still substantial, many low-income and middle-income countries still often use the amphotericin B deoxycholate formulation because of a small number of generic formulations and the high price of the originator LAmB. The pricing of LAmB is also highly variable between countries. Overcoming supply barriers through the availability of additional quality-assured, generic formulations of LAmB at accessible prices would substantially facilitate equitable access and have a substantial effect on mortality attributable to deadly fungal infections.

Mucormycosis, the Black Fungus in the Post-COVID-19 Pandemic: A Case Report with Review of Literature

Mucormycosis, a concerning and often fatal fungal infection, has shown a significant rise in cases following the COVID-19 pandemic in India, particularly affecting patients with uncontrolled comorbidities such as diabetes mellitus and other immunocompromised individuals. Our case series examines five instances of mucormycosis, supported by appropriate radiographic and histopathological evidence correlating with clinical observations. Our review indicated that patients were experiencing ailments or undergoing treatments that compromised their immune systems. We analyzed additional epidemiological data, including common infection sites, gender predispositions, and mortality rates. Treatments were tailored based on symptom severity, encompassing both surgical and medical approaches. The primary reason for the rise in cases was linked to elevated glycaemic levels and weakened immunity among post-COVID-19 patients. The report provides a detailed explanation of the factors contributing to this correlation. Our findings underscore the critical importance of timely surgical intervention and advocate for further investigation into treatment efficacy and symptom monitoring specific to mucormycosis in post-COVID-19 patients in India.

Amphotericin B in the Era of New Antifungals: Where Will It Stand?

Amphotericin B (AmB) has long stood as a cornerstone in the treatment of invasive fungal infections (IFIs), especially among immunocompromised patients. However, the landscape of antifungal therapy is evolving. New antifungal agents, boasting novel mechanisms of action and better safety profiles, are entering the scene, presenting alternatives to AmB's traditional dominance. This shift, prompted by an increase in the incidence of IFIs, the growing demographic of immunocompromised individuals, and changing patterns of fungal resistance, underscores the continuous need for effective treatments. Despite these challenges, AmB's broad efficacy and low resistance rates maintain its essential status in antifungal therapy. Innovations in AmB formulations, such as lipid complexes and liposomal delivery systems, have significantly mitigated its notorious nephrotoxicity and infusion-related reactions, thereby enhancing its clinical utility. Moreover, AmB's efficacy in treating severe and rare fungal infections and its pivotal role as prophylaxis in high-risk settings highlight its value and ongoing relevance. This review examines AmB's standing amidst the ever-changing antifungal landscape, focusing on its enduring significance in current clinical practice and exploring its potential future therapeutic adaptations.

AmBisome® Formulations for Pediatrics: Stability, Cytotoxicity, and Cost-Effectiveness Studies

Liposomal amphotericin B (Ambisome®) is the gold standard for the treatment and prevention of fungal infections both in the adult and pediatric populations. The lyophilized dosage form has to be reconstituted and diluted by hospital staff, but its management can be challenging due to the spontaneous tendency of amphotericin B to form aggregates with different biological activity. In this study, the colloidal stability of the liposomes and the chemical stability of amphotericin B were investigated over time at storage conditions. Three liposomal formulations of amphotericin B at 4.0 mg/mL, 2.0 mg/mL, and 0.2 mg/mL were prepared and assayed for changes regarding the dimensional distribution, zeta potential, drug aggregation state, and onset of by-products. Our analyses highlighted that the most diluted formulation, kept at room temperature, showed the greatest changes in the aggregation state of the drug and accordingly the highest cytotoxicity. These findings are clinically relevant since the lower dosages are addressed to the more vulnerable patients. Therefore, the centralization of the dilution of AmBisome® at the pharmacy is of fundamental importance for assuring patient safety, and at the same time for reducing medication waste, as we demonstrated using the cost-saving analysis of drug expense per therapy carried out at the G. Gaslini children hospital.

Antiparasitic activity of the iron-containing milk protein lactoferrin and its potential derivatives against human intestinal and blood parasites

An iron-containing milk protein named lactoferrin (Lf) has demonstrated antiparasitic and immunomodulatory properties against a variety of human parasites. This protein has shown its capability to bind and transport iron molecules in the vicinity of the host-pathogen environment. The ability of parasites to sequester the iron molecule and to increase their pathogenicity and survival depends on the availability of iron sources. Lf protein has suggested a iron chelating effect on parasites iron and, hence, has shown its antiparasitic effect. Since the parasites have a complex life cycle and have developed drug resistance, vaccines and other treatments are a handful. Therefore, therapeutic research focusing on natural treatment regimens that target the parasite and are non-toxic to host cells is urgently needed. The antiparasitic efficacy of Lf protein has been extensively studied over the past 40 years using both in vitro and in vivo studies. This review article highlighted past important studies on Lf protein that revealed its potential antiparasitic activity against various intracellular and extracellular intestinal or blood-borne human parasites. This review article structures the role of Lf protein in its various forms, such as native, peptide, and nanoformulation, laying the groundwork for its function as an antiparasitic agent and its possible known mechanisms of action.

Potential lipid-based strategies of amphotericin B designed for oral administration in clinical application

Amphotericin B (AmB) is regarded as a first-line therapy against life-threatening invasive fungal infections. Due to its poor oral bioavailability, AmB is restricted to intravenous administration in clinical practice. As science continues to move forward, two lipid-based formulations are successfully developed for oral AmB administration, currently undergoing phase I clinical trials. Encouragingly, lipid-AmB conjugates with emulsions also exhibit a better bioavailability, which may be another strategy to design oral AmB formulation in clinical practice. Thus, this review mainly focused on the two lipid-based formulations in clinical trials, and discussed the potential perspectives of AmB-lipid conjugation-loaded nanocochleates and emulsions.

Prevention and management of antibiotic associated acute kidney injury in critically ill patients: new insights

PURPOSE OF REVIEW

Drug associated kidney injury (D-AKI) occurs in 19-26% of hospitalized patients and ranks as the third to fifth leading cause of acute kidney injury (AKI) in the intensive care unit (ICU). Given the high use of antimicrobials in the ICU and the emergence of new resistant organisms, the implementation of preventive measures to reduce the incidence of D-AKI has become increasingly important.

RECENT FINDINGS

Artificial intelligence is showcasing its capabilities in early recognition of at-risk patients for acquiring AKI. Furthermore, novel synthetic medications and formulations have demonstrated reduced nephrotoxicity compared to their traditional counterparts in animal models and/or limited clinical evaluations, offering promise in the prevention of D-AKI. Nephroprotective antioxidant agents have had limited translation from animal studies to clinical practice. The control of modifiable risk factors remains pivotal in avoiding D-AKI.

SUMMARY

The use of both old and new antimicrobials is increasingly important in combating the rise of resistant organisms. Advances in technology, such as artificial intelligence, and alternative formulations of traditional antimicrobials offer promise in reducing the incidence of D-AKI, while antioxidant medications may aid in minimizing nephrotoxicity. However, maintaining haemodynamic stability using isotonic fluids, drug monitoring, and reducing nephrotoxic burden combined with vigilant antimicrobial stewardship remain the core preventive measures for mitigating D-AKI while optimizing effective antimicrobial therapy.

Pharmacokinetic and pharmacodynamic considerations for antifungal therapy optimisation in the treatment of intra-abdominal candidiasis

Intra-abdominal candidiasis (IAC) is one of the most common of invasive candidiasis observed in critically ill patients. It is associated with high mortality, with up to 50% of deaths attributable to delays in source control and/or the introduction of antifungal therapy. Currently, there is no comprehensive guidance on optimising antifungal dosing in the treatment of IAC among the critically ill. However, this form of abdominal sepsis presents specific pharmacokinetic (PK) alterations and pharmacodynamic (PD) challenges that risk suboptimal antifungal exposure at the site of infection in critically ill patients. This review aims to describe the peculiarities of IAC from both PK and PD perspectives, advocating an individualized approach to antifungal dosing. Additionally, all current PK/PD studies relating to IAC are reviewed in terms of strength and limitations, so that core elements for the basis of future research can be provided.

Critical appraisal beyond clinical guidelines for intraabdominal candidiasis

BACKGROUND

Regardless of the available antifungals, intraabdominal candidiasis (IAC) mortality continues to be high and represents a challenge for clinicians.

MAIN BODY

This opinion paper discusses alternative antifungal options for treating IAC. This clinical entity should be addressed separately from candidemia due to the peculiarity of the required penetration of antifungals into the peritoneal cavity. Intraabdominal concentrations may be further restricted in critically ill patients where pathophysiological facts alter normal drug distribution. Echinocandins are recommended as first-line treatment in guidelines for invasive candidiasis. However, considering published data, our pharmacodynamic analysis suggests the required increase of doses, postulated by some authors, to attain adequate pharmacokinetic (PK) levels in peritoneal fluid. Given the limited evidence in the literature on PK/PD-based treatments of IAC, an algorithm is proposed to guide antifungal treatment. Liposomal amphotericin B is advocated as first-line therapy in patients with sepsis/septic shock presenting candidemia or endophthalmitis, or with prior exposure to echinocandins and/or fluconazole, or with infections by Candida glabrata. Other situations and alternatives, such as new compounds or combination therapy, are also analysed.

CONCLUSION

There is a critical need for more robust clinical trials, studies examining patient heterogeneity and surveillance of antifungal resistance to enhance patient care and optimise treatment outcomes. Such evidence will help refine the existing guidelines and contribute to a more personalised and effective approach to treating this serious medical condition. Meanwhile, it is suggested to broaden the consideration of other options, such as liposomal amphotericin B, as first-line treatment until the results of the fungogram are available and antifungal stewardship could be implemented to prevent the development of resistance.

IFISTRATEGY: Spanish National Survey of Invasive Fungal Infection in Hemato-Oncologic Patients

Recent advances in the treatment of hematologic malignancies have improved the overall survival rate, but the number of patients at risk of developing an invasive fungal infection (IFI) has increased. Invasive infections caused by non-Candida albicans species, non-Aspergillus molds, and azole-resistant Aspergillus fumigatus have been increasingly reported in recent years. We developed a cross-sectional multicenter survey which involved a total of 55 hematologists and infectious disease specialists from a total of 31 Spanish hospitals, to determine the most frequent strategies used for the management of IFIs. Data collection was undertaken through an online survey which took place in 2022. Regarding key strategies, experts usually prefer early treatment for persistent febrile neutropenia, switching to another broad-spectrum antifungal family if azole-resistant Aspergillus is suspected, broad-spectrum azoles and echinocandins as prophylactic treatment in patients receiving midostaurin or venetoclax, and liposomal amphotericin B for breakthrough IFIs after prophylaxis with echinocandins in patients receiving new targeted therapies. For antifungals failing to reach adequate levels during the first days and suspected invasive aspergillosis, the most appropriate strategy would be to associate an antifungal from another family.

New antifungal strategies: drug combination and co-delivery

The growing occurrence of invasive fungal infections and the mounting rates of drug resistance constitute a significant menace to human health. Antifungal drug combinations have garnered substantial interest for their potential to improve therapeutic efficacy, reduce drug doses, reverse, or ameliorate drug resistance. A thorough understanding of the molecular mechanisms underlying antifungal drug resistance and drug combination is key to developing new drug combinations. Here we discuss the mechanisms of antifungal drug resistance and elucidate how to discover potent drug combinations to surmount resistance. We also examine the challenges encountered in developing such combinations and discuss prospects, including advanced drug delivery strategies.

Recent Advances in Strategies to Combat Bacterial Drug Resistance: Antimicrobial Materials and Drug Delivery Systems

Bacterial infection is a common clinical disease. Antibiotics have saved countless lives since their discovery and are a powerful weapon in the fight against bacteria. However, with the widespread use of antibiotics, the problem of drug resistance now poses a great threat to human health. In recent years, studies have investigated approaches to combat bacterial resistance. Several antimicrobial materials and drug delivery systems have emerged as promising strategies. Nano-drug delivery systems for antibiotics can reduce the resistance to antibiotics and extend the lifespan of novel antibiotics, and they allow targeting drug delivery compared to conventional antibiotics. This review highlights the mechanistic insights of using different strategies to combat drug-resistant bacteria and summarizes the recent advancements in antimicrobial materials and drug delivery systems for different carriers. Furthermore, the fundamental properties of combating antimicrobial resistance are discussed, and the current challenges and future perspectives in this field are proposed.