The use of fluconazole and itraconazole in the treatment of Candida albicans infections: a review

Candida albicans is responsible for most fungal infections in humans. Fluco nazole is well established as a first-line management option for the treatm ent and prophylaxis of localized and systemic C. albicans infections. Fluco nazole exhibits predictable pharmacokinetics and is effective, well tolerat ed and suitable for use in most patients with C. albicans infections, inclu ding children, the elderly and those with impaired immunity. Prophylactic a dministration of fluconazole can help to prevent fungal infections in patie nts receiving cytotoxic cancer therapy. The increasing use of fluconazole f or the long-term prophylaxis and treatment of recurrent oral candidosis in AIDS patients has led to the emergence of C. albicans infections that are n ot responsive to conventional doses. Second-line therapy with a wider spect rum anti-fungal, such as itraconazole, should be sought if treatment with f luconazole fails. A solution formulation of itraconazole has recently been introduced to overcome the poor and variable absorption of its original cap sule formulation. Efficacy and tolerability studies in HIV-positive or immu nocompromised patients with C. albicans infections have shown that, althoug h itraconazole solution is as effective as fluconazole, it is less well tol erated as first-line therapy. Itraconazole solution can be effective in AID S patients with C. albicans infections that are non-responsive to fluconazo le. No efficacy or tolerability data are available on the use of itraconazo le solution in children or the elderly.