New Options in Antifungal Therapy: New Drugs, Inhaled Antifungals, and Management of Resistant Pathogens

Abstract

This review aims to update the reader on recent information related to available antifungal pharmacotherapy and inform on agents that may be available for clinical use in the near future. Additionally, alternate drug delivery of existing agents, therapeutic drug monitoring, and management of resistant fungal pathogens will be discussed. Rezafungin (a once-weekly echinocandin) and ibrexafungerp (an oral glucan synthase inhibitor) appear to be the investigational agents that are nearest to widespread use in clinical practice. Emerging information on isavuconazole (mean inhibitory concentrations, drug interactions, side effect profile) suggests increasing utilization is likely to continue. Newer formulations of posaconazole and itraconazole offer more favorable pharmacokinetic profiles, potentially making them more reliable treatment options for clinicians versus the original formulations. While the number of available antifungal agents remains comparatively limited, recent data and new formulations of existing agents are available to aid clinicians until the next wave of new antifungal drug approvals.