Voriconazole for serious fungal infections.
Voriconazole is a new second generation triazole effective against a wide spectrum of fungal pathogens. A randomised, controlled trial has shown it to be superior to amphotericin B in invasive aspergillosis, and it is a potential alternative to amphotericin B in neutropenic sepsis and to fluconazole in oesophageal candidiasis. Early clinical reports and in vitro susceptibility data suggest that it may also be a valuable antifungal against fluconazole-resistant Candida species and certain emerging fungal pathogens, which cause infections that are often refractory to conventional therapies. There is limited evidence of azole cross-resistance of clinical importance. Voriconazole is available as intravenous and oral formulations and has excellent tissue penetration and a good safety profile, the main problems being transient visual impairment and hepatotoxicity in patients with liver disease. It is metabolised by cytochrome P-450 isoenzymes causing important drug interactions but, in contrast to amphotericin B, is safe in renal failure and rarely causes infusion-related reactions. This review outlines the pharmacology of voriconazole and focuses on its clinical applications and safety profile.
Gothard
P
P
Department of Infectious Diseases, Imperial College, Faculty of Medicine, Du Cane Road, London, W12 0NN, UK.
Rogers
T R
TR
D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001230:Aspergillus / Q000187:drug effects; D002175:Candida / Q000187:drug effects; D018849:Controlled Clinical Trials as Topic; D004347:Drug Interactions; D006801:Humans; D009181:Mycoses / Q000188:drug therapy*; D011743:Pyrimidines / Q000494:pharmacology / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D014230:Triazoles / Q000494:pharmacology / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole