A Review of Antifungals and their Mono- and Combination- therapy in the Treatment of Invasive Fungal Infections

Abstract

Invasive fungal infections with high mortality rate are a growing health concern in hospitals and medical centers. The infection usually occurs in people with compromised immune systems. The purpose of this paper is a review of the most commonly prescribed antifungal drugs for invasive fungal diseases.<br /> Antifungals consist of the four main groups; polyenes, azoles, echinocandins and DNA and RNA synthesis inhibitors. Amphotericin B is one of the most significant antifungal agents effective against<em> Aspergillus</em>, <em>Candida</em> and<em> Mucor</em> species, but due to several side effects, it is not used for prophylaxis. Its lipid formulation has lower toxicity. Azoles have an extensive activity against a broad spectrum of filamentous fungi and <em>Candida</em> species.<em> Voriconazole </em>is the drug of choice in the prophylaxis and treatment of the patients susceptible to<em> Aspergillus</em> infections. Posaconazole is an oral azole used to treat mucormycosis.<em>5</em>-fluorocytosine is an antifungal drug with intracellular mechanisms that is used routinely for the treatment of cryptococcal meningitis.<em> Echinocandins</em> are the latest family of antifungal agents and include caspofungin, anidulafungin and micafungin. They <em>are</em> effective against <em>Candida</em> and can serve as an alternative for azoles.<br /> There is a variety of antifungal treatments and monotherapy has been the best; however, to prevent side effects of a medicine with high-dose and resistance, combination treatments are under investigation.