Antifungal drugs in the treatment of systemic candidiosis:: susceptibility to antifungal drugs, point on drug resistance, pharmacological data.

The available antifungal agents are amphotericin B (conventional or lipid formulation), flucytosin and azole derivatives (ketoconazole, fluconazole, itraconazole). The main target of these molecules are a specific compound of fun-gal membrane, ergosterol. Determination of the fungal sensitivity to antifungal drugs is difficult and no consensus has been achieved so far. Minimal inhibitory concentrations are poor predictors of clinical success or failure. A good correlation between in vitro and in vivo results has been observed only in patients with oropharyngeal candidiasis associated with HIV infection. Combinations of antifungal drugs are currently under study. The role of hemopoietic growth factors (G-CSF, GM-CSF) as an adjuvant has not been fully established. New antifungal drugs (triazole derivatives, echinocandins) should be available within months. (C) 2001 Editions scientifiques et medicates Elsevier SAS.