The field of antifungal
chemotherapy is presently rapidly moving. It began in 1903, with the successful use of
potassium iodide (KI). Then there was little progress for 50 years, when in 1951,
nystatin was introduced, the first useful polyene. Four years later
amphotericin B followed, which is still the historical standard against which new systemic antifungals are compared. Except for the development of
flucytosine, there was little progress until the early 1970s and the development of the
azole drugs. The present era, which is characterized largely by the modifications of
azole drugs, began with
ketoconazole and brought agents which can be given orally and have increasing potency, decreasing toxicity and a broader spectrum of activity. Recent studies have examined ways to ameliorate the well-known toxicities of
amphotericin B. A new approach has been to complex the
drug with
lipids or entrap it in
liposomes.
Itraconazole is a broad-spectrum oral
triazole whose greatest advantages over the
imidazoles are in its activity against
aspergillosis and
cryptococcosis, though it is also efficacious against the endemic deep
mycoses.
Fluconazole is a broad-spectrum
triazole. It has been shown to be efficacious in various forms of superficial candidosis, including
esophageal disease. We have shown in a randomized, double-blind, placebo-controlled study that maintenance
therapy can completely prevent
thrush in
AIDS patients with recurrent
thrush and possibly prevent all deep and superficial
mycoses. Other studies have shown efficacy in
cryptococcal meningitis in
AIDS comparable to conventional
therapy and with far less toxicity, and also in prevention of relapse of cryptococcal disease. Early diagnosis of
fungal infections in
cancer patients is problematic.(ABSTRACT TRUNCATED AT 250 WORDS)