Management of systemic fungal infections: alternatives to itraconazole

• Published in: Journal of antimicrobial chemotherapy Vol. 56; no. suppl-1; pp. i39 - i48
• Main Authors: Herbrecht, R., Nivoix, Y., Fohrer, C., Natarajan-Amé, S., Letscher-Bru, V.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-09-2005; Oxford Publishing Limited (England)
• Subjects: amphotericin B; Amphotericin B - adverse effects; Amphotericin B - pharmacology; Amphotericin B - therapeutic use; Antifungal Agents - adverse effects; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; antifungals; azoles; Flucytosine - adverse effects; Flucytosine - pharmacology; Flucytosine - therapeutic use; Humans; Mycoses - drug therapy; Randomized Controlled Trials as Topic; Triazoles - adverse effects; Triazoles - pharmacology; Triazoles - therapeutic use
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dki223

For many years, amphotericin B and flucytosine have been the only antifungal agents for invasive fungal infections. Amphotericin B was the standard of care for most of these infections. However, its use was often associated with low efficacy and poor tolerance. Fortunately, the antifungal armamentarium has increased during the past two decades with the addition of several new agents. In addition to itraconazole and fluconazole, lipid formulations of amphotericin B, voriconazole, caspofungin and micafungin have arrived on the market. Other agents are expected to be licensed shortly (anidulafungin, posaconazole). These various antifungal agents differ in their spectrum, pharmacokinetic profile, route of administration, efficacy in clinical trials, safety profile, drug–drug interactions and, importantly, their cost. There is no longer a unique standard agent for all or nearly all invasive fungal infections but a real choice among several agents. The characteristics of these new agents are reviewed to help clinicians in their decision to select an antifungal agent for their patients.