New Directions in Antifungal Therapy.

Abstract

Development of antifungal therapy continues to be lively, as we strive to approach the ideal therapy. The newest agents include lipid delivery systems for amphotericin B, which promise relief from some of that drug's side effects. The triazoles, itraconazole and fluconazole, have proven their value as non-toxic and orally effective therapy. Newer members of this class, e. g., SCH 56592 and voriconazole, appear to be promising extensions. To date the triazoles' properties enable new strategies of prophylaxis and of early intervention. Areas needing improvement include treatment for newer fungal pathogens not covered by available therapy, and the need for rapid diagnostic capabilities, comparative clinical trials, and better definitions and scoring in trials. Drugs with new and fungal-specific targets may provide a quantum leap in our weaponry. Examples included drugs targeted at chitin synthase (e. g., nikkomycin Z) or beta glucan synthase (e. g., LY303366). Another approach is immunomodulation, and several cytokines can stimulate the host synergistically with conventional antifungal therapy.