Background: Amphotericin B (AMPH B) has served as standard treatment for five decades, but toxic effects often limit its use. Fluconazole (FLCZ) and itlaconazole (ITCZ) have arole in tile treatment of deep-seated fungal infections, performing as well as AMPH-B and with their superior safety. However, poor survival in patients with invasive aspergillosis is one of the most serious issues that must be urgently solved. Certain non albicans Candida species are less susceptible to FLCZ. Candins and new-generation azoles have been developed as a potent solution against such situations. Discttssion: Camiins. Candin class mltifungals target tile fungal cell wall, retaining fungicidal activity against Cmldida isolates resistant to azoles or polyenes. The first randomized controlled trial on candin was published by Mora Duarte etal. in 2002, and showed easpofungin was at least as effective as AMPH B for the treatment of invasive eandidiasis and, more specifically, cmldidemia. Superior safety compared to AMPH-B was also observed in this study. Caspofungin has also been shown to be as effective as and generally better tolerated than lipoanmal AMPH-B when given as empiric antifungal therapy in patients with persistent fever and neutropenia (Ngalsh et al. 2004). Micafungin is another candin, which has shown superior efficacy to a standard prophylactic such as FLCZ, and is approved as a prophylactic antifungal in patients with hematopoietic stem cell transplant. Voricormzole. Vmiconazole (VRCZ) is now recognized as tile first-line antifungal in tile treatment of invasive aspergillosis, based on a clinical study performed by Herbrecht etal. A striking observation in the study was that VRCZ became the first antifungal that showed superior treatment efficacy over AMPH B during this half century. VRCZ is also shown to be effective in refractory ccgptococcosis. Conclusiml: Both candins mid new-generation azoles are tllOl~e promising antifungal agents, but mole evidence is needed.
Full conference title:
International Congress on Chemotherapy, 24th Meeting
- ICC 24 th