Trends in the treatment of systemic mycoses

The incidence of systemic fungal infection has been increasing during the l ast two decades. Candida and Aspergillus spp. are the classical opportunist ic pathogens. Rare fungi, such as Mucor, Rhizopus, Fusarium, Trichosporon, Paecilomyces, Alternaria, Cladosporium and Pseudoallescheria, are emerging as cause of systemic fungal infection in the immunocompromised host. For mo re than 40 years Amphotericin B has been the gold standard of antifungal tr eatment because of its broad spectrum comprising yeasts, dimorphic fungi an d moulds, its nephrotoxicity has led to the development of lipid-associated preparations of amphotericin B: liposomal amphotericin B, amphotericin B c olloidal dispersion and amphotericin B lipid complex. These preparations ar e less nephrotoxic, but higher doses than those of conventional amphoterici n B are needed to achieve the same effect. The triazole fluconazole is the treatment of choice in infections caused by Candida albicans. New antifunga l compounds are voriconazole and the candins, the pradimicin/benanomycin fa mily, nikkomycin Z and a liposomal[ preparation of nystatin.