Invasive fungal infections: recent epidemiology data and new antifungal agents

Rising incidence: In the past two decades, systemic fungal infections, esse ntially invasive candidiasis, but also invasive aspergillosis, has increase d substantially Despite the currently available antifungal drugs, amphoteri cin B (AmB), azole compounds (fluconazole or FLU, itraconazole or ITR), the se infections are associated with significant morbidity and mortality. AmB remains the drug of choice for treatment of most fungal diseases because of its broad spectrum and potent fungicidal activity, but significant side ef fects limit its clinical utility. The azole antifungal agents are easier to take, less toxic than AmB, but their use is limited by multiazole-resistan t strains. New antifungal agents: Lipid formulations have recently attracted much atte ntion due to a significantly lower toxicity: this concerns lipid formulatio ns of AmB and perhaps nystatin in the future.New triazoies (voriconazole, r avuconazole, posaconazole) have shown a wide spectrum of action including a gainst azole-resistant isolates. A new class of antifungal agents, lipopept ides (MK-0991, LY303366, FK463), with an original mechanism of action are b eing developed. These new compounds are reported to possess a large fungici dal activity against most isolates including AmB and azole-resistant mains. (C) 2000, Masson, Paris.