New antifungal agents and bronchopulmonary mycoses

The frequency of respiratory mycosal infections has increased over recent Years. Diagnosis has been improved by recent epidemiological data and advances in radiological and mycological diagnostic methods. Two new antifungal agents have recently received marketing approval: voriconazole and caspofungine. Voriconazole belongs to the echinocandin family of antifungals. Sites of action of antifungals have become more diversified: amphotericins act on ergosterol directly, azolated agents act on the synthesis of ergosterol, flucytosine affects synthesis of nucleic acids, and echinocandins alter the fungal wall. Synergetic or additive combinations, such as amphotericin-caspofungine, or voriconazole-caspofungine, can be proposed for advanced disease. Thus both first intention and secondary treatments, particularly for systemic candidiasis and aspergillosis, have been modified. These new protocols take into consideration the severity of the mycosal infection, co-morbidity, and drug combinations as well as cost.