New antifungal agents

Two new antifungal agents, voriconazole and caspofungin, are now available for treatment of systemic fungal infections. Voriconazole is an extended-spectrum triazole that is fungicidal for filamentous fungi, including Aspergillus, Scedosporium, Fusarium, Paecilomyces, and is active against all species of Candida. It has become first-line therapy for invasive aspergillosis. Voriconazole is given either by the oral or the intravenous route. Clinicians must be aware of drug-drug interactions and side effects, including visual disturbances and photosensitivity rash that can occur when voriconazole is used. Caspofungin is the first drug available from a new class of antifungal agents, echinocandins, that act to inhibit fungal cell wall synthesis. Caspofungin is fungicidal for all species of Candida and more slowly kills Aspergillus species. Caspofungin, available only for intravenous administration, has minimal side effects and very few drug interactions. The echinocandins will find most use for Candida infections and as second-line therapy for Aspergillus infections.