Safety and efficacy of new generation azole antifungals in the management of recalcitrant superficial fungal infections and onychomycosis.

IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Expert Review of Anti-infective Therapy Pub Date : 2024-06-01 Epub Date: 2024-06-12 DOI:10.1080/14787210.2024.2362911
Aditya K Gupta, Mesbah Talukder, Avner Shemer, Eran Galili
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Abstract

Introduction: Terbinafine is considered the gold standard for treating skin fungal infections and onychomycosis. However, recent reports suggest that dermatophytes are developing resistance to terbinafine and the other traditional antifungal agents, itraconazole and fluconazole. When there is resistance to terbinafine, itraconazole or fluconazole, or when these agents cannot used, for example, due to potential drug interactions with the patient's current medications, clinicians may need to consider off-label use of new generation azoles, such as voriconazole, posaconazole, fosravuconazole, or oteseconazole. It is essential to emphasize that we do not advocate the use of newer generation azoles unless traditional agents such as terbinafine, itraconazole, or fluconazole have been thoroughly evaluated as first-line therapies.

Areas covered: This article reviews the clinical evidence, safety, dosage regimens, pharmacokinetics, and management algorithm of new-generation azole antifungals.

Expert opinion: Antifungal stewardship should be the top priority when prescribing new-generation azoles. First-line antifungal therapy is terbinafine and itraconazole. Fluconazole is a consideration but is generally less effective and its use may be off-label in many countries. For difficult-to-treat skin fungal infections and onychomycosis, that have failed terbinafine, itraconazole and fluconazole, we propose consideration of off-label voriconazole or posaconazole.

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新一代唑类抗真菌药治疗顽固性浅部真菌感染和甲癣的安全性和有效性。
简介特比萘芬被认为是治疗皮肤真菌感染和甲癣的金标准。然而,最近的报告显示,皮癣菌正在对特比萘芬和其他传统抗真菌药物(伊曲康唑和氟康唑)产生抗药性。如果对特比萘芬、伊曲康唑或氟康唑产生抗药性,或者由于这些药物可能与患者目前服用的药物发生相互作用等原因而无法使用,临床医生可能需要考虑在标签外使用新一代唑类药物,如伏立康唑、泊沙康唑、福斯拉康唑或奥替康唑。必须强调的是,我们不主张使用新一代唑类药物,除非特比萘芬、伊曲康唑或氟康唑等传统药物已被彻底评估为一线疗法:本文回顾了新一代唑类抗真菌药物的临床证据、安全性、剂量方案、药代动力学和管理算法:专家观点:在处方新一代唑类抗真菌药物时,抗真菌管理应是重中之重。特比萘芬和伊曲康唑是一线抗真菌治疗药物。氟康唑也在考虑之列,但其疗效通常较差,而且在许多国家,氟康唑的使用可能不在标签范围内。对于特比萘芬、伊曲康唑和氟康唑治疗无效的难治性皮肤真菌感染和甲真菌病,我们建议考虑标签外使用伏立康唑或泊沙康唑。
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来源期刊
CiteScore
11.20
自引率
0.00%
发文量
66
审稿时长
4-8 weeks
期刊介绍: Expert Review of Anti-Infective Therapy (ISSN 1478-7210) provides expert reviews on therapeutics and diagnostics in the treatment of infectious disease. Coverage includes antibiotics, drug resistance, drug therapy, infectious disease medicine, antibacterial, antimicrobial, antifungal and antiviral approaches, and diagnostic tests.
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