Recent trends in antifungal therapy: focus on systemic mycoses

Amphotericin B (AmB) remains the 'gold standard' for systemic antifungal therapy and newer drug delivery systems have been effectively developed for this drug. The newer azoles e.g. itraconazole, voriconazole and their derivatives are viable alternatives to AmB, and are suitable for oral administration. Combination antifungal therapy has been tried successfully. For instance, AmB plus flucytosine is preferred in cryptococcal meningitis and candidemia. A liquid preparation of itraconazole and cyclodextrin is pharmacokinetically superior to the conventional dosage form of itraconazole, and is particularly effective in mycoses following cytotoxic chemotherapy and bone marrow transplants. Newer potential antifungals such as echinocandins, benanomicins/pradimicins, aureobasidins and nikkomycins are under clinical trials. The role of -immunomodulation in systemic anti-fungal therapy has been proposed and recombinant cytokine therapy (G-CSF, GM-CSF, IFN-g, IL-I, TNF-a) either alone or in combination with AmB have shown good results.