Antifungal azoles: old and new.

Management of fungal infections is complex with increasing choice of antifungals. Mortality and morbidity are significant despite treatment. Azoles are commonly used compounds which inhibit fungal lanosterol 14 demethylase, thereby depleting ergosterol in the fungal cell membrane with the accumulation of lanosterol precursors. Imidazoles (miconazole, ketoconazole, clotrimazole) are used in topical preparations. Triazoles are used for prophylaxis, empirical and directed systemic antifungal therapy, and will be the focus of this review. There are important differences in structure, spectrum of activity, pharmacokinetics, drug interactions, and clinical indications.