Azoles: Back to the future

Purpose of review Azoles are among the oldest class of antifungals, and they continue to be integral to the treatment of invasive fungal infections. This review examines the place of azoles in the treatment of invasive candidiasis and aspergillosis, and their use in the management of diseases caused by rare but emerging opportunistic molds. Recent findings Standard azoles have utility as prophylaxis for invasive candidiasis and posaconazole for prophylaxis of invasive aspergillosis in high-risk patients, but the optimal conditions for prophylaxis deployment are still being investigated. Standard azoles are important for initial treatment or as step-down therapy for candidemia and voriconazole for initial treatment of aspergillosis. There is hope that nonculture-based microbiological tools enabling detection of biomarkers for candidemia or aspergillosis may lead to earlier intervention and improved outcomes for these infections. The newer triazoles with broader-spectrum activity may be helpful in the management of a variety of diseases associated with non-Aspergillus molds such as fusariosis, scedosporiosis, and phaeohyphomycosis. Posaconazole, but not voriconazole, is also active against disease-causing zygomycetes. Summary The role of azoles in the management of serious invasive fungal infections continues to evolve, with ongoing research further defining and broadening their uses. It is critical that clinicians stay abreast of the latest data supporting the current and evolving roles of these important agents. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Duke Scholars

Author John Robert Perfect Medicine, Infectious Diseases