title: The future of antifungal therapy.
abstract: In the late 1970s the options for systemic antifungal therapy doubled with the addition of intravenous miconazole and oral ketoconazole to the two previously available agents, amphotericin B and flucytosine. The 1980s ushered in the next generation of triazole antifungals, fluconazole and itraconazole. These are the present-day mainstays of treatment for some of the most serious systemic fungal infections. However, the increase in the numbers and types of fungal pathogens, and especially the emergence of azole-resistant fungi, have prompted a continuing search for new therapeutic options. This search has yielded more-potent triazole antifungals, new vehicles for both polyenes and triazoles, and entirely new classes of agents such as the echinocandin derivatives; in addition, it has prompted the evaluation of new combinations of present-day antifungals and exploration of the use of immunomodulators for treatment of fungal infections. Rapid developments in molecular mycology are permitting a concentrated search for more targets for antifungals. We are entering a new era of antifungal therapy in which we will continue to be challenged by systemic fungal diseases but will have greatly expanded options for treatment.
authors.affiliation: Department of Medicine, University of Texas Health Science Center, San Antonio 78284, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Graybill
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D000818:Animals; D000935:Antifungal Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D006801:Humans; D016919:Meningitis, Cryptococcal / Q000188:drug therapy; D009172:Mycology / Q000639:trends; D009181:Mycoses / Q000188:drug therapy* / Q000517:prevention & control; D012106:Research / Q000639:trends
chemical_list: D000276:Adjuvants, Immunologic; D000935:Antifungal Agents; D000666:Amphotericin B