Developments in the treatment of candidiasis: more choices and new challenges

Abstract

The incidence of oesophageal candidiasis, candidaemia and disseminated candidiasis has increased dramatically. In addition to the amphotericin B formulations and fluconazole, the echinocandins anidulafungin, caspofungin and micafungin and the newer triazoles posaconazole and voriconazole are in the last stages of development and are becoming available for the management of candidiasis. This review presents these new agents and addresses their role in the treatment of candidiasis. All new antifungal agents exhibit potent activity against Candida spp. and echinocandins are fungicidal against most Candida spp. but appear to be less potent against certain species, such as Candida parapsilosis and C. guilliermondii. Systemic antifungal therapy can now be individualised based on the severity of the infection, comorbid conditions and the Candida spp. causing the infection. Studies are needed to investigate the possible development of resistance and the efficacy of these antifungal agents against the more resistant Candida spp.

Keywords::

• anidulafungin
• BAL4815
• Candida
• candidaemia
• candidiasis
• caspofungin
• FK463
• L-743872
• LY303366
• micafungin
• MK-0991
• posaconazole
• SCH56592
• UK-109496
• voriconazole

Acknowledgments

Financial support was provided by a K08 award AI63084 from the NIH and a New Scholar Award in Global Infectious Diseases of the Ellison Medical Foundation to E Mylonakis. All of the authors are non-conflicting. G Aperis and N Myriounis contributed equally to the work.