Korean J Med Mycol.
2005 Dec;10(4):135-143.
New Systemic Antifungal Agents and Clinical Applications
- Affiliations
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- 1Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea. krpeck@smc.samsung.co.kr
Abstract
- Current antifungal agents, such as amphotericin B, fluconazole and itraconazole, have limitations in clinical use because of toxicity, low efficacy, and drug resistance. Newer systemic antifungal agents are available for better efficacy and lower toxicity. They include antifungal agents of a new class and a new generation of an existing class. Caspofungin, the first available echinocandin, inhibits cell wall synthesis and has broad antifungal spectrums. Caspofungin shows better antifungal activity against fluconazole resistant Candida and Aspergillus. Caspofungin was very effective in salvage therapy for amphotericinrefractory or intolerant aspergillosis. Voriconazole, the first available second-generation triazole, is a derivative of fluconazole. Voriconazole is more active against Aspergillus than other antifungal agents and shows lower MIC (minimal inhibitory concentrations) against Candida. The clinical efficacy of voriconazole in the treatment of invasive aspergillosis is superior to amphotericin B. Voriconazole has some limitations, including visual adverse events, liver enzyme elevation as well as a number of drug interactions. Caspofungin and voriconazole should be judiciously used in clinical practices based on clinical efficacy, adverse events, and costs.
