A Review of Antifungals and their Mono- and Combination- therapy in the Treatment of Invasive Fungal Infections

Invasive fungal infections with high mortality rate are a growing health concern in hospitals and medical centers. The infection usually occurs in people with compromised immune systems. The purpose of this paper is a review of the most commonly prescribed antifungal drugs for invasive fungal diseases. Antifungals consist of the four main groups; polyenes, azoles, echinocandins and DNA and RNA synthesis inhibitors. Amphotericin B is one of the most significant antifungal agents effective against Aspergillus, Candida and Mucor species, but due to several side effects, it is not used for prophylaxis. Its lipid formulation has lower toxicity. Azoles have an extensive activity against a broad spectrum of filamentous fungi and Candida species. Voriconazole is the drug of choice in the prophylaxis and treatment of the patients susceptible to Aspergillus infections. Posaconazole is an oral azole used to treat mucormycosis.5-fluorocytosine is an antifungal drug with intracellular mechanisms that is used routinely for the treatment of cryptococcal meningitis. Echinocandins are the latest family of antifungal agents and include caspofungin, anidulafungin and micafungin. They are effective against Candida and can serve as an alternative for azoles. There is a variety of antifungal treatments and monotherapy has been the best; however, to prevent side effects of a medicine with high-dose and resistance, combination treatments are under investigation.