Itraconazole, fluconazole, and amphotericin B in antifungal therapy

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Abstract
Although amphotericin B remains the drug of choice for most serious fungal infections, especially in immunocompromised patients, experience is increasing with fluconazole and itraconazole. Fluconazole is available in intravenous as well as oral forms, is absorbed well from the gastrointestinal tract, and achieves excellent levels in cerebrospinal fluid. It has proved efficacious in primary treatment as well as prevention of relapse of cryptococcal meningitis. However, many clinicians still use amphotericin B with flucytosine for initial treatment and then follow with fluconazole. Itraconazole, although not yet released in the United States, has proved efficacious in the treatment of the endemic mycoses (histoplasmosis, blastomycosis, sporotrichosis, coccidioidomycosis). It is the first oral antifungal drug with good activity against Aspergillus spp, and early studies show promise in the response of localized and disseminated forms of aspergillosis to treatment with itraconazole.

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