Developments in the treatment of candidiasis: more choices and new challenges.
The incidence of oesophageal candidiasis, candidaemia and disseminated candidiasis has increased dramatically. In addition to the amphotericin B formulations and fluconazole, the echinocandins anidulafungin, caspofungin and micafungin and the newer triazoles posaconazole and voriconazole are in the last stages of development and are becoming available for the management of candidiasis. This review presents these new agents and addresses their role in the treatment of candidiasis. All new antifungal agents exhibit potent activity against Candida spp. and echinocandins are fungicidal against most Candida spp. but appear to be less potent against certain species, such as Candida parapsilosis and C. guilliermondii. Systemic antifungal therapy can now be individualised based on the severity of the infection, comorbid conditions and the Candida spp. causing the infection. Studies are needed to investigate the possible development of resistance and the efficacy of these antifungal agents against the more resistant Candida spp.
Aperis
George
G
Massachusetts General Hospital, Division of Infectious Diseases, Gray-Jackson 504, 55 Fruit Street, Boston, MA 02114, USA.
Myriounis
Nikolaos
N
Spanakis
Elias K
EK
Mylonakis
Eleftherios
E
D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects; D002177:Candidiasis / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004353:Drug Evaluation, Preclinical; D015507:Drugs, Investigational / Q000627:therapeutic use*; D006801:Humans; D008826:Microbial Sensitivity Tests
D000935:Antifungal Agents; D015507:Drugs, Investigational