Abstract
The introduction of several new antifungals has significantly expanded both prophylaxis and treatment options for invasive fungal infections (IFIs). Relative to amphotericin B deoxycholate, lipid-based formulations of amphotericin B have significantly reduced the incidence of nephrotoxicity, but at a significant increase in drug acquisition cost. Newer, broad-spectrum triazoles (notably voriconazole and posaconazole) have added significantly to both the prevention and treatment of IFIs, most notably Aspergillus spp. (with voriconazole) and the treatment of some emerging fungal pathogens. Finally, a new class of parenteral antifungals, the echinocandins, is employed most frequently against invasive candidal infections. While the role of these newer agents continues to evolve, this review summarizes the activity, safety and clinical applications of agents most commonly employed in the treatment of IFIs.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. However, Dr Richard Drew has the following disclosures: Commercial: Astellas (consultant), Cubist (research, speaker), Ortho-McNeil (consultant), Wyeth/Pfizer (consultant), Merck/Schering-Plough (consultant, research, speaker), UpToDate (publication royalties); Non-commercial: CustomID (development team), Moses Cone Health System (speaker), Society of Critical Care Medicine (speaker), American Society of Microbiology (speaker).
This paper was first published online on Early Online on 7 March 2011.