Key Points

• While most Candida albicans remain sensitive to fluconazole and amphotericin B, fluconazole-resistant C. albicans and non-albicans Candida spp. that may be less susceptible to azoles are being recognized with increased frequency.

• C. krusei is resistant and C. glabrata demonstrates decreased susceptibility to fluconazole. C. lusitaniae is resistant to amphotericin B and flucytosine, but remains susceptible to azoles.

• Aspergillus spp. do not respond to fluconazole, but amphotericin B and itraconazole may have efficacy, especially if predisposing immune defects can be corrected.

• Itraconazole now plays an important role in management of blastomycosis and histoplasmosis, although amphotericin B is still used for severe disease.

• Treatment of zygomycosis, hyalohyphomycosis, and phaeohyphomycosis is challenging and involves aggressive antifungal therapy, adjunctive surgery if possible, and correction of underlying immune defects.

• Guidelines for management of dermatomycoses have been published by the American Academy of Dermatology.

• Susceptibility testing for Candida species and Cryptococcus neoformans has now been standardized but is still used predominantly for exceptional patient care decisions and research purposes.

• New antifungal drugs are urgently needed and several are currently being studied.

• Practice guidelines are available from the IOSA to guide treatment of many fungal diseases (31).

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