Systemic New Antifungal Agents

Cho, Yong Kyun

Abstract

Voriconazole is a second-generation triazole that has an enhanced antifungal spectrum, compared with older triazoles. It will likely become the drug of choice for treatment of invasive aspergillosis and many Scedosporium/Pseudallescheria and Fusarium infections. Voriconazole should not replace fluconazole or other antifungal agents for treatment of most Candida infections. The drug has more side effects and drug interactions than fluconazole. The oral formulation, with its excellent bioavailability, is available it is especially beneficial in patients with renal failure, who should not be exposed to the cyclodextrin vehicle used for the intravenous formulation. Caspofungin, the first inhibitor of fungal beta -1, 3 glucan synthesis, is effective for the treatment of mucosal and invasive candidiasis and invasive aspergillosis. It is also active in vitro and in animal models against a number of other filamentous and dimorphic endemic fungi and in animal models of Pneumocystis carinii infection. Caspofungin has an excellent safety profile. Caspofungin may prove to be useful in empirical therapy for suspected invasive fungal infections. Additional clinical trial data that expand our knowledge of the usefulness of caspofungin for these and other mycoses is anticipated. The broad spectrum antifungal itraconazole is an effective and well tolerated agent for the prophylaxis and treatment of systemic fungal infections. The recent development of an itraconazole oral solution and an intravenous itraconazole solution has increased the options for the use of this drug. Intravenous itraconazole solution is at least as effective as intravenous amphotericin B in the empirical treatment of neutropenic patients with systemic fungal infections, and drug-related adverse events are more frequent in patients treated with amphotericin B. A large proportion of patients with confirmed aspergillosis also respond to the treatment with intravenous itraconazole followed by oral itraconazole. Liposomal nystatin is another promising antifungal agent that might be effective for treatment of invasive candidiasis and invasive aspergillosis. More clinical data, however, is needed for clinical application.