Systemic Antifungal Agents

Schematically, the current systemic antifungal agents can be divided into two categories: that of the antifungal antibiotics, which include griseofulvin and amphotericin B (AMB), and that of the chemical agents, which comprise all of the other molecules, flucytosine (5FC), the extremely rich series of azoles and, more recently, the allylamines and echinocandins. Given their value in the treatment of systemic mycoses, the authors discuss the three systemic azoles currently commercially available in parallel with voriconazole, which is currently available under an authorization for compassionate use, and conclude with the most recent triazoles under development. The azole compounds possess a relatively broad spectrum against numerous pathogenic or opportunistic fungal species, a spectrum that is exceeded only by that of AMB. Although all of these derivatives share good activity against some of these fungi (such as Candida albicans, Candida neoformans, and dimorphic fungi), major differences have been found in vitro and subsequently confirmed in animals and in clinical trials. Despite the considerable advances in antifungal therapy over the last few years, we are still far from possessing the ideal antifungal and progress is still necessary. Fungal infections remain a matter of concern, particularly in severe neutropenia (frequent inefficacy in disseminated mycoses) and AIDS (frequency of relapses and/or resistance in oroesophageal candidosis and cryptococcosis).