[Future directions of antimycotic therapy]

There are presently numerous developments in the field of antifungal armamentarium. Amphotericin B has been considered as the standard treatment since the fifties for most invasive fungal infections. However, emergence of resistant strains and failures despite adequate treatment with amphotericin B are numerous and toxicity as well as side effects are limiting factors in many patients. Alternative modalities to administer amphotericin B using liposomal or lipid formulations are presently evaluated. Tremendous research has been performed in the development of new azoles including ketoconazole, fluconazole and itraconazole. The emergence of resistant strains of yeasts in patients treated with fluconazole requires attention. The problem of possible cross resistance for all azoles should be a matter of further investigation. Itraconazole is a new broad-spectrum antifungal agent. But due to its pharmacokinetic properties monitoring of serum concentrations is recommended in life-threatening situations. New formulations of itraconazole are currently under development and may be extremely useful. The role of azole antifungals for prophylactical administration or therapeutic purposes must be balanced carefully. Studies designed to evaluate adjuvant antifungal treatment based on G-CSF, M-CSF or GM-CSF in combination to antifungals would be useful. Future directions of antifungal treatments should include evaluation of combination of antifungal agents to each other. There is a tremendous need for pivotal clinical studies in the field of antifungal treatments which need international collaboration in order to collect rapidly significant numbers of data. Such comprehensive approaches are initiated by the EORTC Invasive Fungal Infections Cooperative Group, and all European clinicians taking care of mycosis patients are invited to cooperate.