Refractory systemic mycoses
Systemic fungal infections in which first-line therapy (fluconazole, itraconazole, voriconazole) failed or was not tolerated. A severe infection in immunocompromised patients.
ICD-10 B492 drugs
Also known as: Systemic fungal infections, Deep mycoses
Drugs used for this condition
- APosaconazoleFirst line · Second-generation systemic triazole antifungalTreats refractory systemic mycoses including mucormycosis, fusariosis, coccidioidomycosis and chromoblastomycosis. SEIMC positions posaconazole as first-line for mucormycosis after liposomal amphotericin B.
- BKetoconazoleSecond line · Systemic antimycotics. Imidazole derivativesSystemic ketoconazole is used only in severe systemic mycoses when alternative azoles (fluconazole, itraconazole, voriconazole) and echinocandins are contraindicated, unavailable or ineffective. After the 2013 FDA review, it lost its first-line indications due to the risk of fulminant hepatic failure. The EMA in 2013 recommended withdrawal of oral formulations for fungal infections. International IDSA guidelines consider it a salvage option after other agents have been exhausted.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit