New methods for delivery of antifungal agents

Amphotericin B remains the drug of choice for many invasive fungal infections. However, failures of therapy, relapses, and adverse effects are numerous. New modalities of antifungal therapy are extensively evaluated, including various preparations of liposomal amphotericin B and promising new agents such as itraconazole and fluconazole. Numerous studies indicate the potential benefit of liposomal amphotericin B. In particular, a dramatic decrease in the incidence of immediate adverse effects as compared with the incidence with amphotericin B complexed with deoxycholate has been documented. In addition, a prolonged in vitro antifungal activity has been observed with unilamellar liposomes. As yet there is no standardized commercially available preparation of liposomal amphotericin B. Extensive research in this field is in progress. Large comparative studies for the evaluation of the clinical efficacy of these preparations are planned. Intranasal administration of amphotericin B seems useful for the prevention of aspergillosis in predisposed patients. These various approaches should improve the management and prognosis of fungal infections.