Current and emerging azole antifungal agents

Major developments in research into the azole class of antifungal agents du ring the 1990s have provided expanded options for the treatment of many opp ortunistic and endemic fungal infections. Fluconazole and itraconazole have proved to be safer than both amphotericin B and ketoconazole. Despite thes e advances, serious fungal infections remain difficult to treat and resista nce to the available drugs is emerging. This review describes present and f uture uses of the currently available azole antifungal agents in the treatm ent of systemic and superficial fungal infections and provides a brief over view of the current status of in vitro susceptibility testing and the growi ng problem of clinical resistance to the azoles. Use of the currently avail able azoles in combination with other antifungal agents with different mech anisms of action is likely to provide enhanced efficacy. Detailed informati on on some of the second-generation triazoles being developed to provide ex tended coverage of opportunistic endemic, and emerging fungal pathogens, as well as those in which resistance to older agents is becoming problematic, is provided.