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PMID: 6297871 Published · ppublish English Journal Article Review

Antifungal agents used in systemic mycoses. Activity and therapeutic use.

Drugs ·Vol. 25 ·No. 1 ·1983-01-00 ·Pages 41-62

Graybill JR, Craven PC

Abstract

The development of the polyene antibiotic, amphotericin B, provided for the first time a drug which was clinically effective in many serious mycotic diseases. Unfortunately, it requires parenteral administration and is often toxic, factors which limit the total cumulative dose which can be given. Efforts to utilise combinations of amphotericin B with other agents were best realised with amphotericin B/flucytosine in cryptococcal meningitis, and to a lesser degree in systemic candidiasis. More recently, the introduction of new imidazoles has extended the range of applications of these drugs to fungal diseases. Two members of this group, miconazole and ketoconazole, are promising agents. Miconazole is a parenterally administered agent for patients acutely ill with candidiasis and other mycotic infections. It may be the drug of choice for Petriellidium boydii infections and it is an attractive alternative to amphotericin B for intrathecal administration to patients with fungal meningitis. Ketoconazole offers much less toxicity, the advantage of oral administration, and the possibility of indefinitely prolonged therapy. However, it does not attain high concentrations in either the urine or cerebrospinal fluid. With the imidazoles, we have entered a new era of antifungal therapy which may produce even better antifungal agents than those currently available.

MeSH Terms
Amphotericin B/metabolism,pharmacology,therapeutic use Antifungal Agents/therapeutic use Central Nervous System/drug effects Flucytosine/therapeutic use Humans Imidazoles/metabolism,pharmacology,therapeutic use,toxicity Ketoconazole Kidney/drug effects Kidney Diseases/metabolism Kinetics Miconazole/metabolism,therapeutic use Mycoses/drug therapy Piperazines/metabolism,therapeutic use,toxicity
Chemicals
Antifungal Agents Imidazoles Piperazines Miconazole Amphotericin B Flucytosine Ketoconazole
Authors & Affiliations
2 authors, click to expand affiliations / ORCID
Graybill J R
Craven P C
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Article Info
Journal
Drugs
Abbr.
Drugs
ISSN
0012-6667
DOI
10.2165/00003495-198325010-00003
Published
1983-01-00
Pages
41-62
Language
English
Region
New Zealand
NLM ID
7600076
Subset
IM
External Links
PubMed source DOI: 10.2165/00003495-198325010-00003 View journal details
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