Abstract
Invasive fungal diseases primarily occur in immunocompromised patients. Immunosuppression
has become more prevalent due to novel treatments, and this has led to a rise in the
incidence of invasive fungal diseases. The antifungal armamentarium has long been
insufficient and has taken quite some time to become diverse. Antifungal spectrum,
tolerability, and toxicity are critical issues. Amphotericin B and its lipid formulations
still have the widest spectrum, but, in spite of the better tolerance of the lipid
formulations, toxicity remains a drawback, mostly with regard to renal function. Azoles
constitute a heterogeneous antifungal class, in which newer molecules have an improved
spectrum of activity. The main concern for the clinician when using azoles relates
to the management of their many potential drug–drug interactions in an often fragile
patient population. Echinocandins are better tolerated but possess a narrower antifungal
spectrum and lack an oral route of administration. Still, their fungicidal activity
makes them a weapon of first choice against Candida species. For certain uncommon fungal infections, antifungals such as flucytosine
and terbinafine can also be useful. This article will give an overview of the mechanisms
of action of currently used antifungals, as well as their spectrum of activity, clinically
relevant pharmacological features, drug–drug interactions, and frequent side effects,
all of which should drive the clinician's choice of agent when managing invasive fungal
infections.
Keywords
amphotericin B - liposomal amphotericin B - triazoles - echinocandins - olorofim -
rezafungin - ibrexafungerp - manogepix - pharmacokinetics - drug-drug interaction
