New systemic antifungal drugs: mechanisms of action,drug interactions and side effects

New antifungal agents are needed to match the currently increasing rate of systemic fungal infections and the development of resistant fungal strains. This appears possible by the introduction of second generation azole antifungals which potently inhibit ergosterol synthesis, but also by a partial synthetic echinocandin analogue which acts by the suppression of the enzyme glucan synthase. Voriconazole and caspofungin have been approved for the treatment of invasive aspergillosis. Both drugs are well tolerated if contraindications and--with voriconazole--also possible drug interactions are respected. Possibly these drugs are also suitable for other severe fungal infections including systemic and oropharyngeal candidosis in the immunocompromised host.