Chapter 9 - Systemic and topical antifungal drugs

Abstract

Although the existence of fungi is necessary for the balance of ecosystems, over the period of time, it is apparent that some of the fungi are capable of causing some serious infections in humans. The incidence of systemic fungal infections is quite less as compared with the superficial infections, but higher mortality associated with systemic infections is of great concern. Additionally, patients on immunosuppressive medications and/or anticancer therapies and individuals infected with acquired immunodeficiency syndrome are also highly susceptible to severe invasive mycoses, further contributing to the morbidity and mortality associated with the fungal infections. The current antifungal therapy mainly includes polyenes, azoles, echinocandins, allylamines, and antimetabolites but is also known to possess several limitations, such as undesirable adverse effects, narrow spectrum of activity, and occurrence of fungal resistance. As drug-resistant fungal pathogens continue to emerge, undeniably newer strategies or regimens are necessary to combat these life-threatening infections. This chapter highlights the different types of fungal infections and describes the current systemic and topical antifungal agents available for clinical use. In addition, different antifungal resistance mechanisms are also summarized, including recent medicinal chemistry approaches in the development of antifungal agents.