Fungicidal versus Fungistatic: what's in a word?
BACKGROUND
Historically clinicians have preferred to use 'cidal' antifungal agents, particularly in critically ill patients. However, data to support the belief that the preferential use of a 'cidal' agent results in better patient outcomes has been lacking.


OBJECTIVE
This review examined the in vitro definitions of fungicidal and fungistatic as well as their strengths and limitations.


METHODS
A Medline search was performed in order to identify literature that examined the in vitro or in vivo impact of fungicidal and fungistatic activity. The study examined three common invasive fungal infections, namely cryptococcal meningitis, candidemia and invasive aspergillosis, where sufficient comparisons of fungicidal and fungistatic agents have been performed to allow for the evaluation of the clinical importance of these in vitro findings.


CONCLUSIONS
A clear clinical benefit of fungicidal agents over those with fungistatic activity remains elusive. Patients with cryptococcal meningitis clearly benefit from early fungicidal therapy but require long-term suppression. The data in invasive Candida sp. infections are tantalizing and suggest that fungicidal therapy may be important. However, the data for invasive aspergillosis do not support the hypothesis that fungicidal activity improves outcomes.
Lewis
James S
JS
University Health System, Department of Pharmacy, 4502 Medical Drive, San Antonio, TX 78229, USA. james.lewis@uhs-sa.com
Graybill
John R
JR
D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy*; D001230:Aspergillus / Q000187:drug effects; D002175:Candida / Q000187:drug effects; D002177:Candidiasis / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D003453:Cryptococcosis / Q000188:drug therapy*; D003454:Cryptococcus / Q000187:drug effects; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D016919:Meningitis, Cryptococcal / Q000188:drug therapy; D008828:Microbiological Techniques; D011090:Polyenes / Q000494:pharmacology / Q000627:therapeutic use; D014230:Triazoles / Q000494:pharmacology / Q000627:therapeutic use
D000935:Antifungal Agents; D054714:Echinocandins; D011090:Polyenes; D014230:Triazoles