Journal de Pharmacie Clinique


The good use of antifungal drugs in the treatment of invasives candidosis and aspergillosis Volume 24, issue 3, juillet-août-septembre 2005


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Service pharmacie - Laboratoire de pharmacologie, CHU Henri Mondor, Créteil, Service pharmacie, Hôpital Saint-Joseph, Paris, Laboratoire de parasitologie-mycologie, CHU Henri Mondor, Créteil

Fungal infections are severe and their incidence has grown considerably in the last years because of the increase number of immunosupressive patients and invasives medical and chirurgical operations. That is why the number of antifungal treatments increases. Currently antifungal drugs are flucytosine, amphotericin B using with differents galenic formulations, azole drugs and caspofungin. Flucytosine, used in association, presents an efficacy and medullar- and hepato-toxicities which are correlated with seric concentrations. A therapeutic monitoring of flucytosine is essential. Amphotericin B has a good efficacy and a large antifungal spectrum. The new galenic formulations limit his nephrotoxicity. Azoles drugs have a complex pharmacokinetic and a different affinity for human cytochromes which induces many drugs interactions. Amongst them, itraconazole and voriconazole present interesting spectrum and activity notably in severe pathologies. In brief, caspofungin has interesting antifungal properties in the cases of refractory infections and intolerance. We analyse some recommandations for the use and optimization of these cost and long treatments.