New agents for the treatment of fungal infections: clinical efficacy and gaps in coverage.
The incidence of fungal infections has increased globally, and the introduction of the newer triazoles and echinocandin antifungals is a more-than-welcome and long overdue development. In this report, we review the clinical trials evaluating the therapeutic efficacy of these new antifungal agents and examine possible gaps in coverage. Voriconazole has become the primary treatment for most forms of invasive aspergillosis in a number of centers, posaconazole offers a broad antifungal spectrum, and echinocandins are fungicidal against most Candida species. Moreover, the new agents are active against some fungi that are resistant to amphotericin B, may have a role in the management of fever and neutropenia, and provide exciting options for combination antifungal therapy. However, significant questions remain, including the management of breakthrough infections and treatment failures and the efficacy of the new antifungal agents against less common fungi.
Spanakis
Elias K
EK
Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA.
Aperis
George
G
Mylonakis
Eleftherios
E
D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy; D002177:Candidiasis / Q000188:drug therapy; D000077336:Caspofungin; D002986:Clinical Trials as Topic; D003453:Cryptococcosis / Q000188:drug therapy; D054714:Echinocandins; D005334:Fever / Q000188:drug therapy; D006801:Humans; D055666:Lipopeptides; D008074:Lipoproteins / Q000627:therapeutic use; D000077551:Micafungin; D009181:Mycoses / Q000188:drug therapy*; D009503:Neutropenia / Q000188:drug therapy; D010456:Peptides, Cyclic / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; C101425:posaconazole; D000077336:Caspofungin; D065819:Voriconazole; D000077551:Micafungin