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Fungicidal versus Fungistatic: what's in a word?

James S Lewis1, John R Graybill

  • 1University Health System, Department of Pharmacy, 4502 Medical Drive, San Antonio, TX 78229, USA. james.lewis@uhs-sa.com

Expert Opinion on Pharmacotherapy
|April 2, 2008
PubMed
Abstract

Insights

Clinicians often prefer fungicidal antifungal agents, but evidence for better outcomes is limited. This review found no clear clinical benefit of fungicidal over fungistatic agents, except for early cryptococcal meningitis treatment.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Clinicians historically favor fungicidal antifungal agents for critically ill patients.
  • Evidence supporting improved patient outcomes with fungicidal agents is lacking.
  • This review addresses the in vitro definitions and clinical relevance of fungicidal vs. fungistatic activity.

Purpose of the Study:

  • To review the definitions of fungicidal and fungistatic antifungal activity.
  • To evaluate the clinical significance of these in vitro properties.
  • To assess the impact of fungicidal vs. fungistatic agents on patient outcomes in specific invasive fungal infections.

Main Methods:

  • Systematic literature search of Medline for studies on fungicidal and fungistatic activity.
  • Focused analysis on cryptococcal meningitis, candidemia, and invasive aspergillosis.
  • Evaluation of studies comparing fungicidal and fungistatic agents in these infections.

Main Results:

  • A definitive clinical advantage of fungicidal over fungistatic agents is not established.
  • Early fungicidal therapy benefits cryptococcal meningitis patients, requiring subsequent suppression.
  • Data for invasive Candida infections suggest potential benefits of fungicidal therapy.
  • Evidence for invasive aspergillosis does not support improved outcomes with fungicidal activity.

Conclusions:

  • The clinical benefit of fungicidal antifungal agents over fungistatic agents remains uncertain.
  • Specific fungal infections show varied responses to fungicidal vs. fungistatic therapy.
  • Further research is needed to clarify the role of fungicidal activity in invasive fungal infections.

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