[Antifungal agents in otorhinolaryngology]

Numerous progresses are realized in the chemotherapy of mycoses, particularly in the field of deep mycoses due to 3 categories of systemic antifungal agents: polyenes (oral nystatin, oral and intravenous amphotericin B), 5-fluorocytosine (oral and intravenous) and imidazole derivatives (oral and intravenous miconazole, oral ketoconazole). The old drugs as nystatin and amphotericin B per os continue to have a remarkable effect in oro-pharyngeal candidosis, chiefly after sufficient local contact with the mucos membranes; topical preparation are effective in fungal O.R.L. localizations (aspergillar or candidal otomycoses, glossitis). IV amphotericin B is indicated in naso-orbital-cerebral mucor mycosis, nasosinusal aspergillosis, candidosis, entomophthoromycoses and particularly systemic mycoses (histoplasmosis, blastomycosis, coccidioidomycosis) in spite of severe toxicity. 5-fluorocytosine (100-200 mg/kg) has a limited spectrum to Candida, Cryptococcus neoformans, Aspergillus fumigatus infections if the strains are sensitive to this agent (5% primary resistance). Among the new imidazole derivatives, ketoconazole (400 mg/day) represent a revolutionary antifungal agent due to a very large antifungal spectrum, absence of toxicity, rapid diffusion by oral way, and high therapeutic efficiency in candidosis, histoplasmosis, blastomycosis, rhino-entomophthoromycosis... Oral miconazole has a poor diffusion into the tissues and by intravenous way necessitates several injections daily to obtain therapeutic levels. Numerous imidazole derivatives (econazole, miconazole, clotrimazole etc...) can be successfully utilized by topical application, as well as numerous other local antifungal agents.