Chapter 14. Progress with antifungal agents and approaches to combat fungal resistance

Abstract

Publisher Summary This chapter reviews the progress with antifungal agents and approaches to combat fungal resistance. The rising incidence of serious fungal infections attests to the need for more effective therapies. All current agents have some serious liabilities: inadequate spectrum, limited dosage forms, narrow therapeutic window, and rapid emergence of resistance. The search for new agents, particularly those with a novel mode of action, continues unabated. Several new azoles are poised to have an impact on the treatment of mycoses, and the echinocandins continue to show promise as a novel class of antifungal agents, particularly for parenteral use. Other classes continue to be explored, as the demand for alternative therapies remains high. The chapter reviews publications since 1998 pertaining to new agents under development for the treatment of systemic fungal infections, and detail those mechanisms of resistance to established agents that have been demonstrated to be of clinical relevance, together with approaches to combat them. New agents under development are discussed, including azoles, chinocandins/pneumocandin, aureobasidins, pradimicins and benanomycins, polyoxins and nikkomycins, and sordarins. Clinically-important mechanisms of antifungal resistance are elaborated.