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Antifungal agents.

Sharon C A Chen1, Tania C Sorrell

  • 1Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia. sharonc@icpmr.wsahs.nsw.gov.au

The Medical Journal of Australia
|October 3, 2007
PubMed
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This review outlines key antifungal drug classes, including older agents like fluconazole and newer options such as echinocandins. It details their uses, efficacy against various fungi, and potential side effects for effective clinical application.

Area of Science:

  • Pharmacology
  • Mycology
  • Infectious Diseases

Background:

  • Antifungal drugs are crucial for treating superficial and invasive fungal infections.
  • Understanding the different classes and their specific applications is essential for effective patient care.

Purpose of the Study:

  • To review the main classes of antifungal drugs.
  • To highlight clinically useful older and newer antifungal agents.
  • To discuss their spectrum of activity, efficacy, and safety profiles.

Main Methods:

  • Literature review of established and emerging antifungal therapies.
  • Analysis of drug classes including polyenes, azoles, allylamines, and echinocandins.
  • Evaluation of specific agents like fluconazole, itraconazole, amphotericin B, terbinafine, caspofungin, voriconazole, and posaconazole.

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Main Results:

  • Older agents include topical azoles, first-generation triazoles, amphotericin B, and terbinafine.
  • Newer agents include echinocandins (e.g., caspofungin) and second-generation triazoles (e.g., voriconazole, posaconazole).
  • Voriconazole and posaconazole exhibit broad-spectrum activity; posaconazole is unique in its activity against zygomycetes. Echinocandins are effective against Candida and Aspergillus.

Conclusions:

  • Azoles are generally safe but require monitoring for drug interactions and side effects (e.g., visual disturbances with voriconazole, liver transaminase elevations, rashes).
  • Caspofungin has a favorable safety profile with minimal adverse effects.
  • Combination antifungal therapy may be considered for invasive fungal infections based on clinical judgment.