Healthcare Professionals

At Mylan, we produce medicines of the highest quality while ensuring that we maintain good global standards, which is why Mylan applies one global quality standard across its facilities and product line. 

HIV Care

Mylan has a comprehensive portfolio of  antiretroviral (ARV) products for the treatment of HIV/AIDS. We believe that Mylan can set a new standard in the treatment of HIV/AIDS in India by providing health care providers and those living with the disease access to high quality, affordable medicines .

  • Cable 1

    AZT impairs immunological recovery on first-line ART: A collaborative analysis of cohort studies in Southern Africa.

    Zidovudine (AZT) is a chosen first-line antiretroviral therapy (ART) in limited resource settings. Anemia and impaired immunological response are the concerns with the use of AZT. A research by Wandeler et al. compared the CD4 counts in patients treated with AZT and patients not treated with AZT over the period of five years in South Africa, Botswana, Zambia or Lesotho. The research concluded that AZT is associated with inferior immunological recovery compared to other backbones. Replacing AZT with another nucleoside analog reverse-transcriptase inhibitor could avoid unnecessary switches to second-line ART.

    Source: Wandeler G, Gsponer T, Mulenga L, et al. AIDS. 2013;27(14):2225–2232.

    Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment 

    This study by Zaidi et al. has investigated trends of the prevalence of HIV in a rural South African community after the scale-up of antiretroviral treatment (ART) in 2004. There was a significant increase in adult HIV prevalence. This increase may be because of increased survival of HIV-infected people due to ART. Further studies on the same line may explain whether this increase in prevalence is due to treatment success rather than prevention failure.

    Source: Zaidi J, Grapsa E, Tanser F, et al. AIDS. 2013:27(14):2301–2305.

    Impact of Late Presentation on the Risk of Death among HIV-Infected People in France (2003–2009) 

    According to a recent consensus, “late presentation” (LP) during the course of HIV is considered as AIDS irrespective of CD4 cell count or with CD4 <350 cells per cubic millimeter. A study by Montlahuc et al. examined the frequency and predictors of LP and its impact on mortality as per the new definition. The study found that LP with HIV infection is common in France and is associated with increased mortality even in presence of moderate immunodeficiency. Thus, early testing and access to care is a need of the hour.

    Source: Montlahuc C, Guiguet M, Abgrall S, et al. J Acquir Immune Defic Syndr. 2013;64(2):197–203.

  • Cable 2

    Effects of pill burden on discontinuation of the initial HAART regimen in minority female patients prescribed 1 pill/day versus any other pill burden

    In Human Immunodeficiency Virus (HIV), Highly Active Anti-Retroviral Therapy (HAART) is considered as most important therapeutic option. However, second-line HAART can be expensive and less effective. Thus, understanding the duration of initial HAART is important. Hill et al. recently conducted a study with the aim of estimating the effects of daily pill burden on the time to discontinuation of the initial HAART regimen. Research found that discontinuations were less likely if the patient was treated with 1 pill/day HAART regimen vs. >1 pills/day HAART regimen.

    Source: Hill S, Kavookjian J, Qian J, et al. AIDS Care. 2014;26(5):595–601.

    Temporal Association between Incident Tuberculosis and Poor Virological Outcomes in a South African Antiretroviral Treatment Service

    A recent study by Gupta-Wright et al. evaluated temporal relationship between incident tuberculosis (TB) and virological outcomes during antiretroviral therapy (ART). Poor virological outcomes were reported when TB was present with ART therapy during 6 months following TB diagnosis. The mechanism behind the poor virological outcomes is not known. However, virological monitoring and treatment adherence support may be beneficial in ART patients suffering from TB.

    Source: Gupta-Wright A, Wood R, Bekker LG, et al. J Acquir Immune Defic Syndr. 2013;64(3):261–270.

    Prospective Antiretroviral Treatment of Asymptomatic, HIV-1 Infected Controllers

    Studying HIV-infected ‘‘controllers’’ who are able to maintain low levels of plasma HIV RNA in the absence of antiretroviral therapy (ART) can provide insights for HIV cure and vaccine strategies. A recent study by Hatano et al. confirmed that HIV replication persists in controllers and contributes to a chronic inflammatory state. ART should be considered for these individuals.

    Source: Hatano H, Yukl SA, Ferre AL, et al. PLoS Pathog. 2013;9(10):e1003691.

    Duration of HIV-1 Viral Suppression on Cessation of Antiretroviral Therapy in Primary Infection Correlates with Time on Therapy

    A study by Stöhr et al. examined whether the duration of antiretroviral therapy (ART) was associated with post-treatment viraemic control, showed that probability of viral control was higher after stopping ART if the ART duration was longer in primary HIV-1 infection (PHI).

    Source: Stöhr W, Fidler S, McClure M, et al. PLoS One. 2013;8(10):e78287.


  • Cable 3

    Infection duration and inflammatory imbalance are associated with atherosclerotic risk in HIV-infected never-smokers independent of antiretroviral therapy

    A recent study by Desvarieux et al. examined whether increased atherosclerotic risk among HIV-infected individuals is because of antiretroviral therapy (ART) or HIV infection. The study also examined if the risk is present in never-smokers and also researched the association of inflammatory profiles with risk of atherosclerosis. The research showed that risk of HIV infection was associated with thickness of carotid intima-media maximal thickness (c-IMT), irrespective of ART in carefully selected age-matched never-smoking HIV-treated and ART-naïve male individuals. Higher levels of anti-inflammatory markers were protective in nature.

    Source: Desvarieux M, Boccara F, Meynard JL, et al. AIDS. 2013;27(16):2603–2614.

    Clinical impact of altered T-cell homeostasis in treated HIV patients enrolled in a large observational cohort

    A recent study by Ndumbi et al. investigated the probability of transitioning in or out of the CD3+ T-cell homeostatic range during antiretroviral therapy. The study also assessed the clinical impact of lost T-cell homeostasis (TCH) on AIDS-defining illnesses (ADIs) or death. The study found that ADIs/death risk was high among patients with very low or high CD3+ T-cell percentages. This was the first study which linked altered TCH and morbidity/mortality in cART-treated HIV-positive patients.

    Source: Ndumbi P, Gillis J, Raboud JM, et al. for Canadian Observational Cohort (CANOC) collaboration. AIDS. 2013;27(18):2863–2872.

    The effects of age on associations between markers of HIV progression and markers of metabolic function including albumin, haemoglobin and lipid concentrations

    A recent study investigated age-modified associations between markers of HIV progression, CD4 T-lymphocyte count and HIV RNA viral load (VL), and the following markers of metabolic function: albumin, haemoglobin, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). The study showed that CD4 count and plasma albumin and haemoglobin levels are modified by age. There was greater reduction in haemoglobin and albumin concentrations among older people living with HIV with reduced CD4 counts. The study shed light on metabolic impact of HIV influenced by age.

    Source: Samuel M, Jose S, Winston A, et al. for UK Collaborative HIV Cohort Study. HIV Med. 2014;15(5):311–316.

    Incomplete adherence to antiretroviral therapy is associated with higher levels of residual HIV-1 viremia

    A recent study by Li et al. evaluated the relationship between incomplete antiretroviral therapy (ART) adherence and levels of residual HIV-1 viremia. The study showed that higher levels of residual HIV-1 viremia and detectable residual viremia are present among the patients despite of 100% measured ART adherence.

    Source: Li JZ, Gallien S, Ribaudo H, et al. AIDS. 2014;28(2):181–186.


  • Cable 4

    Temporal effect of HLA-B*57 on viral control during primary HIV-1 infection

    A recent study by Vaidya et al. examined the role of HLA-B alleles in viral control during the acute phase of HIV-1 infection and establishment of the early viral load set point (VLSP). The research concluded that the effect of HLA-B*57 on viral control is more evident during later stage of primary HIV-1 infection. The finding suggest that the mechanism of HLA-B*57 effect on viral control manifests during first several months after HIV-1 infection, which is a critical period in pathogenesis. Polymorphisms at position 97 of HLA-B is found to be the key factor.

    Source: Vaidya SA, Streeck H, Beckwith N, et al. Retrovirology. 2013;10:139. doi: 10.1186/1742-4690-10-139.

    Advanced HIV Disease at Entry into HIV Care and Initiation of Antiretroviral Therapy during 2006-2011: Findings from Four Sub-Saharan African Countries

    Early diagnosis, prompt enrollment and engagement in HIV care are the key to timely antiretroviral therapy (ART). A recent study by Lahuerta et al. examined trends in advanced HIV disease (CD4+ count <100 cells/µL or World Health Organization disease stage IV) and determinants of advanced HIV disease at ART initiation in a large sample size. The study concluded that there is a need for intense efforts to identify and link HIV-infected individuals to care earlier and retain them in continuous pre-ART care to ensure timely initiation of ART.

    Source: Lahuerta M, Wu Y, Hoffman S, et al. Multi-level determinants of late ART initiation in sub-Saharan Africa Team and; Identifying Optimal Models of HIV Care in sub-Saharan Africa Collaboration. Clin Infect Dis. 2014;58(3):432–441.

    Treatment as long-term prevention: Sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda

    A recent observational cohort study by Siedner et al. measured the frequency and correlates with periods of transmission risk among individuals taking antiretroviral therapy (ART) during multiple years of observation in rural, southwestern Uganda. The study showed that although 50% of the population showed detectable viremia and/or sexual transmission risk behavior, ART decreased the period of HIV transmission risk by over 90% during 6 years of observation time.

    Source: Siedner MJ, Musinguzi N, Tsai AC, et al. AIDS. 2014;28(2):267–271.

    ‘If I am given antiretrovirals I will think I am nearing the grave’: Kenyan HIV serodiscordant couples’ attitudes regarding early initiation of antiretroviral therapy

    A recent qualitative study by Curran et al. explored HIV serodiscordant couples’ attitudes toward early initiation of antiretroviral therapy (ART). The study concluded that although the couple understood the potential benefits of early antiretroviral therapy, they viewed ART as signifying AIDS and approaching mortality. Thus, it is important to initiate ART early as well as to educate the patient and partner about ART.

    Source: Curran K, Ngure K, Shell-Duncan B, et al. AIDS. 2014;28(2):227–233.


  • Cable 5

    Body mass index changes during highly active antiretroviral therapy in Nigeria

    Wasting is a significant problem among HIV patients receiving highly active antiretroviral therapy (HAART). A study by Denue et al. evaluated the factors that determine the effect of HAART on body mass index (BMI). The research concluded that there is a relationship between time-updated CD4 count and increase in BMI. The study also suggested that BMI could be a surrogate for CD4 count in monitoring treatment response.

    Source: Denue BA, Ikunaiye PN, Denue CB. East Mediterr Health J. 2014;19(Suppl 3):S89–97.

    Risk of Tuberculosis among HAART Receiving HIV Patients Attending an ART Centre of West Bengal, India: A Prospective Cohort Study

    A prospective study by Saha et al. examined the incidence density rate and attributed risk factors of Tuberculosis (TB) development among ART receivers. The study suggested that, in the presence of past history of TB or World Health Organization (WHO) clinical stage 3 or 4 TB, attention has to be paid for early diagnosis of TB in order to prevent the silent transmission and multidrug resistance development of TB in the community.

    Source: Saha R1 Saha I. J Community Health. 2014;39(5):935–942.

    Potential drug–drug interactions in HIV-infected children on antiretroviral therapy in Lagos, Nigeria

    A study conducted in a large HIV clinic in Lagos, Nigeria, investigated the prevalence of significant drug interactions (CSDIs) between antiretroviral (ARV) and co-prescribed drugs for children. The study concluded that there is a tendency for CSDIs between ARV and co-prescribed drugs. Thus, it is important to take measures to prevent the CSDIs and manage the unavoidable ones.

    Source: Oshikoya KA, Oreagba IA, Lawal S, et al. HIV AIDS (Auckl). 2014;6:49–59.


Onco Care

Mylan aims at providing holistic cancer care by bringing to the community a broad range of differentiated products manufactured at state-of-the-art facilities. Our mission is to provide cancer patients access to our strong portfolio of high quality medicines available at affordable prices for treating common types of cancers like breast, lung, and colorectal cancer. At Mylan, we conduct patient-oriented programs in which health care professionals also play a pivotal role in spreading awareness about cancer.

  • Biosimilars : Myths and Facts

    Myths and Facts about Biosimilars

    Myth: Biosimilars have a degree of variability and are not the same as reference medicine (existing biological medicine).

    Fact:   The active substance of a biosimilar and its reference medicine is biologically the same.1

    There are no clinical differences between the biological product and the reference product in terms of safety, purity and potency. 1

    Like the reference medicine, the biosimilar has a degree of natural variability. 1         

    Myth: Efficacy of biosimilars may not be the same as reference molecule.

    Fact:   A decrease in potency or lack of efficacy of a medicine is a pharmacovigilance issue and is thoroughly monitored.2

    No evidence of this has been found even after five years of European Union (EU) experience with marketed biosimilars.2

                Any concerns regarding sub-potency are allayed by the fact that the
                pivotal studies are all equivalence trials, or at a minimum are
                non-inferiority studies in line with regulatory requirements.2

    Myth: Safety may be a concern with Biosimilars

    Fact:   The safety of biosimilars is established by a number of quality
                (Chemistry, Manufacturing & Control—CMC) tests; nonclinical and
                clinical tests usually include a complex, 12-month clinical
                immunogenicity investigation using a variety of systematic antibody analysis.2

                Not only is the Biosimilar Medicinal Product (BMP) thoroughly compared
                with the Reference Medicinal Product (RMP) for similarity, but every point
                of difference is also carefully and critically assessed in the context of benefit-risk ratio.2

    Myth: Development of Biosimilar is not required, if originator product is made available.

    Fact:   Being an expensive adjuvant, a monoclonal antibody (mAb) might not be used in oncology in unsupported health care systems, but a biosimilar might.2

    In some poorer countries, biosimilars fulfill an unmet medical need. In
    developing countries worldwide, a biologic medicine might be affordable
    only on the introduction of the biosimilar.2

    Myth: Immunogenicity is an issue with biosimilar monoclonal antibodies

    Fact:  A biosimilar monoclonal antibody can be expressed from various yeast, E.coli, rodent or mammalian cell species that have different immunogenicities.2

                For instance, process changes from chimeric (stem-iximab) to humanized
                mAbs (stem-zumab) have progressively decreased risk of immunogenicity.2

    Biosimilar developers follow the Reference Medicinal Product (RMP)   profile and processes to closely match the excipients and packaging components to avoid irregularities.2



    1. European Medicines Agency. Questions and answers on biosimilar medicines (similar biological medicinal products). Available at: Accessed on 18th June 2014
    2. Hoss A. Dowlat. How Safe Are Biosimilars?; Implications of FDA and EMA Guidances and European Experience since 2006. Available at: Accessed on 18th June 2014


  • Ashray - A Comprehensive Patient Care Program for HER2+ Metastatic Breast Cancer Patients

    Currently in India the awareness about “Breast Cancer” is pretty low which is leading to the loss of many precious lives due to late or no detection of this dreadful disease.

    Low awareness of this disease also results in lot of myths & incorrect information among the general public creating psychological barriers in the minds of patients to pursue the right treatment.

    Study done by one of the Top Cancer Institutes in the country also conclude that “Financial Burden limits the access to HER2 target therapy in more the 90% Patients”.

    The challenge does not just end there, the news of being HER2+ metastatic breast cancer would unsettle any patient & her family – Emotionally, Psychologically and Financially.

    • The patient would go through a mental trauma when she learns that she is patient of metastatic breast cancer.
    • The lack of awareness and knowledge about the disease surrounds her with apprehensions to fight the disease.
    •  Financial burden of the therapy refrains her from obtaining the best treatment.

    These roadblocks in the minds of the patients’ results in non-compliance to the therapy leading to increased morbidity and mortality rates.

    Mylan addresses these concerns  of her & her family through its unique offering of a
    A Comprehensive Patient Care Program 

    Comprehensive Patient Care Program consists of ---        

    Understanding that the need of the hour is Affordable Trastuzumab which will address the concern of treatment gap, Mylan launches  Trastuzumab under the brand name “Hertraz” for increasing access & improving affordability of Indian patients with HER 2+ve metastatic breast cancer.

    At Mylan, access is beyond affordable medicine. Acknowledging this conviction, Mylan introduces “Ashray” a Comprehensive Patient Care aiming to ease the disquiet of every patient of breast cancer and her family.

    “Ashray” means “Shelter”, as its name conveys, it provides shelter to its patients through a holistic approach by supporting Emotionally, strengthening Psychologically and assisting Financially.

    Emotional Support

    A woman when she discovers the bitter truth that she is suffering from HER2 +ve metastatic breast cancer, she would undergo an emotional turmoil and start disassociating herself from the society.

    The “Emotional Support“ element under Ashray aims to revive her womanhood, make her feel part of the society and feel wanted by the family.

    The Welcome Kit which every patient receives on enrolling in to Ashray is desgined to make her feel that she is still “ a beautiful woman” who deserves a rightful place in the society.

    The welcome kit consits of a -

    1. Smuff : This is a stretchable multipurpose scarf made of breathable cotton and could be used as a scarf when she is going though the hair fall phase during chemotherapy, could be used to protect herself from pollution, she could also use this after her treatment like a hair band, wrist band and many more.

    2. Mirror : We would like to remind her that she still looks beautiful.

    3. Shower Caps : Could be used during regular showers.

    4. Sanitizer : To remind her importance of hygeine and to protect her from Infections.

    5. Moisturizer : To keep her skin moist and overcome the dryness of skin caused during her treatment.

    6. Wet Tissues : To make her feel fresh always.

    In addition to this welcome kit, to make the patient emotionally strong to fight the disease, through Ashray Motivational Stories and Video of the breast cancer survivors will be shared with the patients.

    Psychological Support with right information

    It is not only that she is going through an emotional upheavel but also fenced by many fears. The “Psychological Support” element under Ashray allays her fears and rebuilds the confidence.

    Psychological Support is provided by educating and DIRECTing her to the right medical information in her own language through tele-conselling.

    The Information shared are on ---

    Medication Access Support to reduce Financial Burden

    Mylan believes that money should not be a limiting factor for the patient to get the best available treatment.

    To help the patient have access to drug therapy and in an effort to support in continuing the treatment conditional free therapy support on Mylan’s Trastuzumab is provided to the enrolled patients.

    In addition to this, based on special recommendation of the doctor, those who are found to be in need for greater support in continuing therapy due to poor affordability will be given one additional cytotoxic drug from the Mylan product-portfolio mentioned below:

    1. Paclitaxel (Stritoxol)
    2. Docetaxel (Stridotere)
    3. Epirubicin (Stribicin)
    4. Doxorubicin (Stridox)

  • Best of San Antonio Breast Cancer Symposium

    Global trends in breast cancer incidence and mortality

    Dr. Ismail Jatoi discussed about the breast cancer trends across the world, the differences in trends between the eastern and western parts of the globe and the possible reasons for these differences. One of the important points raised was the epidemiology of subtype of breast cancer and the differences in epidemiology in different parts of the world. Breast cancer mortality was also discussed in detail.
    Play Video

    The differences between global and Indian breast cancer trends

    Dr. Purvish Parikh discussed the Indian trends of breast cancer using data from the Indian Cancer Society’s (ICS) population based cancer registry from four districts of Maharashtra, Cancer Atlas of Indian Counsel of Medical Research (ICMR) and Tata Memorial Hospital based cancer registry. He also compared the cancer prevalence in different time periods over the last few decades, the various challenges related to the management of breast cancer in India and how they are different in comparison to the rest of the world. During the course of his talk, he stressed on the importance of identifying our own solutions to the problems and challenges associated with breast cancer in India.
    Play Video

    Understanding the basics of breast cancer

    Dr. Richardson discussed the basic principles of clinical care of breast cancer including diagnosis and treatment.  Her talk also covered the histology, pathology, molecular profiling and molecular biology of breast cancer and its role in diagnosis and management.
    Play Video

    The challenges in the management of breast cancer

    Dr. Porter discussed the challenges related to the management of three subtypes of breast cancer namely triple negative breast cancer, HER2-positive breast cancer and breast cancer in young women. She pointed out the possibility of false negative test for estrogen receptor due to improper methods followed in the laboratory. While significant heterogeneity was a major challenge associated with triple negative breast cancer, inaccessibility to full range of drugs, heterogeneity of the diseases, inadequacy of single agent blockage, drug resistance and personalizing approaches are the problems associated with the management of HER2-positive breast cancer. The challenges of breast cancer in young women are risk factor differences, higher metastasis risk, problems associated with fertility and pregnancy, quality of life and survival rates.
    Play Video

    Management of node-positive and node-negative breast cancer

    Dr. Ismail Jatoi talked about node-positive and node-negative breast cancer. He highlighted the historical background of the current management of node-positive and node-negative breast cancer. The impact of early vs. delayed treatment in the management of disease in axilla and treatment options in node-positive and negative disease were also discussed.
    Play Video

    Clinical trial end-points in breast cancer

    Dr. Andrea Richardson discussed about phases of clinical trials. She detailed objectives of each phase of the trial and discussed about the end-points for each phase of cancer clinical trials.

    Some of the key points related to each phase are as follows: Phase I trials are done to find out the right dose and safety of a new drug and consists of 10-50 patients. Phase II trials are done to identify preliminary evidence of efficacy, evaluate safety and consists of hundreds of patients. Phase III trials are done to compare the efficacy between different drugs and are large trials consisting more than thousand patients. Dose-limiting toxicities (DLT) is the end-point of phase I trial in order to evaluate maximum tolerated dose to arrive at a recommended dose. With regards to phase II trials, single arm and randomized trials are commonly used. End-points of phase II trials are clinical response, pathological response, disease free survival (DFS), progression free survival (PFS), and recurrence rate (RR). Phase III trials are generally comparative efficacy trials. The common end-points are recurrence free survival and overall survival.
    Play Video

Women's Care

Female infertility and various other women’s health problems need more attention and focus in India. In this direction, Mylan offers several therapy options to address the concerns of women’s health and wellbeing such as Hormone Replacement Therapy (HRT), In-Vitro Fertilization (IVF), pre- and post-natal nutrition.
  • “Visna” – For Symptomatic Vaginal Dryness and Dyspareunia

    Vaginal dryness and Vulvovaginal atrophy (VVA) is a long-lasting and progressive medical condition. It has been estimated to affect up to 50%-60% of postmenopausal women.1 Many women in reproductive age group, such as breast feeding women and those in perimenopause (or in the transitional period) may also experience periodic vaginal dryness and associated problems. It results as a part of hormonal changes or VVA, which commonly occurs in menopausal women. As a result some women can have uncomfortable symptoms of vaginal dryness, painful coitus (Dyspareunia) affecting sexual health, burning vaginal discomfort or itching, or abnormal vaginal discharge.2

    Symptomatic VVA can influence lifestyle, relationship and significantly impair the quality of life (QOL) of postmenopausal women.3 It can impact female sexual health and functionality, which are important part of attaining a normal physical and mental health, emotional and social well-being in addition to reproduction. 

    The primary goal of treating vaginal dryness and atrophy is to relieve uncomfortable symptoms of vaginal dryness, and to improve the quality of life.  Choice of therapy depends on the severity of symptoms, the effectiveness and safety of therapy for the individual patient, and patient preference. Along with hormonal and non-hormonal treatment, improving vulvar hygiene, educational guidance and lifestyle modification can influence the outcome of treatment.

    Non-hormonal vaginal lubricants and moisturizers are first-line therapies to alleviate symptoms of VVA.3 Their regular use can alleviate symptoms such as vaginal itching, irritation, and dyspareunia.

    “Visna” (Visnadine) from Mylan is a non-hormonal solution for the management of vaginal dryness and dyspareunia.  Visnadine has an anti-phosphodiesterase activity, causing vascular smooth muscle cell relaxation. It mainly acts at microcirculatory level, increasing the blood volume and blood flow rate in capillary network, thus promoting blood perfusion into the vaginal tissues and the surrounding area of its application. Two to three grams of Visna, applied daily on the clitoris and labia majora for 4–6 weeks provides long-lasting relief from vaginal dryness and dyspareunia. Visna shows desired effect within 15–20 minutes.   


    2. Menopause: The Journal of the North American Menopause Society. Vol. 20, No. 9, pp. 888/902
    3. Management of symptomatic Vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Position statement. Menopause: The Journal of The North American Menopause Society. 2013;20(9):888–902.

Critical Care

Good critical care in medicine often makes a world of difference between life and death. Mylan’s Critical Care division caters to the need of seriously ill patients in Intensive Care Units (ICUs), offering anti-fungal, antibiotic and anticoagulant therapies.