[Invasive fungal infections. Epidemiology and new therapies].
RISING INCIDENCE: In the past two decades, systemic fungal infections, essentially invasive candidiasis, but also invasive aspergillosis, has increased substantially. Despite the currently available antifungal drugs, amphotericin B (AmB), azole compounds (fluconazole or FLU, itraconazole or ITR), these infections are associated with significant morbidity and mortality. AmB remains the drug of choice for treatment of most fungal diseases because of its broad spectrum and potent fungicidal activity, but significant side effects limit its clinical utility. The azole antifungal agents are easier to take, less toxic than AmB, but their use is limited by multiazole-resistant strains. NEW ANTIFUNGAL AGENTS: Lipid formulations have recently attracted much attention due to a significantly lower toxicity: this concerns lipid formulations of AmB and perhaps nystatin in the future. New triazoles (voriconazole, ravuconazole, posaconazole) have shown a wide spectrum of action including against azole-resistant isolates. A new class of antifungal agents, lipopeptides (MK-0991, LY303366, FK463), with an original mechanism of action are being developed. These new compounds are reported to possess a large fungicidal activity against most isolates including AmB and azole-resistant strains.
Granier
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Service de Médecine interne et Maladies infectieuse, CH F. Quesnay, boulevard Sully, F 78200 Mantesla-Jolie. ftremo@hotmail.com
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000453:epidemiology; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology; D004352:Drug Resistance, Microbial; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D009761:Nystatin / Q000627:therapeutic use; D012307:Risk Factors; D014230:Triazoles / Q000627:therapeutic use
D000935:Antifungal Agents; D014230:Triazoles; D009761:Nystatin; D000666:Amphotericin B