Itraconazole: managing mycotic complications in immunocompromised patients

Patients with immune depression are at increased vulnerability to a variety of mycotic infections. These range from mucosal and disseminated candidiasis to invasive aspergillosis to regional mycoses, such as histoplasmosis and Penicillium morneffei, and the emerging mycoses including zygomycetes, phaeohyphomycetes, Fusarium sp, Trichosporon sp, and others. An increasing variety of antifungal drugs, among which are fluconazole and itraconazole, are used for the treatment of these opportunistic infections. Fluconazole has excellent absorption, linear renal excretion of largely active drug, and limited spectrum, primarily against yeast pathogens such as Candida sp. In its capsule formulation, itraconazole has broader activity, including mycelial pathogens, but suffers from irregular absorption, lack of intravenous formulation, and complex hepatic excretion. Itraconazole has recently undergone reformulation as a solution, which gives significant added advantages in bioavailability and increases the practical applications. It is at present unclear whether voriconazole, SCH56592, or itraconazole solution will be equally potent and have a similar range of applications.