Antifungal therapy for the treatment of CNS infections

A review of existing and emerging therapies for the treatment of fungal infections of the CNS is presented, highlighting more recent studies. Newly authorized and emerging therapies and the data surrounding their use are also introduced.

Early data suggests Ibrexafungerp, a newly released antifungal for the treatment of vulvovaginal candidiasis, does not have a significant role in the treatment of CNS infections. Combination therapy including therapy with terbinafine appears promising for difficult-to-treat fungal infections of the CNS. Antifungal treatment remains pathogen-specific but in resource-available areas, liposomal amphotericin B or triazole are the first line for CNS fungal infections. A one-time liposomal amphotericin B infusion followed by flucytosine and fluconazole can be considered for persons living with HIV in resource-poor areas.

Pathogen-specific management is reviewed and the latest evidence surrounding treatment is discussed.