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| Voriconazole - Better chances for patients with invasive mycoses |
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| Author(s): Ghannoum MA, Kuhn DM |
| Source: EUROPEAN JOURNAL OF MEDICAL RESEARCH Volume: 7 Issue: 5 Pages: 242-256 Published: MAY 31 2002 |
| Times Cited: 74 References: 102 |
| Abstract: The past two decades have witnessed an increase in serious fungal infections, without corresponding growth in available antifungal agents. Voriconazole (VRC) is a novel triazole antifungal, recently approved in Europe for treatment of serious infections caused by Aspergillus, Fusarium, Scedosporium, and resistant Candida species. Voriconazole has in vitro activity against yeasts and yeast-like fungi similar, or superior to, fluconazole (FLC), itraconazole (ITC) and amphotericin B (AMB). Candida albicans is generally the most susceptible yeast (VRC MIC90 of 0.06 mug/ml); C. krusei often has low MICs even in the face of FLU/ITC resistance. Voriconazole has demonstrated comparable, or better, in vitro activity than ITC and AMB against Aspergillus (mean MICs 0.19-0.58 mug/ml), Ascomycetes, Bipolaris, Fusarium, Blastomyces dermatitidis, Coccidioides immitis, dermatophytes, Histoplasma capsulatum, Malassezia, and Scedosporium angiospermum (P. boydii). The drug possesses potent fungicidal activity against moulds including Aspergillus, Scedosporium, and Fusarium. Fungicidal activity is likely due to the high affinity of VRC for fungal 14-alpha-demethylase, a concept supported by ultrastructural and biochemical analysis. Animal studies confirmed the activity of VRC against infections including pulmonary and invasive aspergillosis (IA); A. fumigatus endocarditis; fusariosis; pulmonary cryptococcosis; and invasive candidiasis. Most importantly, well-designed human clinical trials have confirmed the efficacy of VRC in the treatment of candidal esophagitis, IA, and febrile neutropenia. Smaller studies and case reports have shown VRC is useful for salvage therapy of IA, cerebral aspergillosis, Scedosporium, and other fungal infections. Clinical testing has shown VRC is safe and well tolerated; the most common side effect is benign, self-limited visual disturbance. |
| Document Type: Review |
| Language: English |
| Reprint Address: Ghannoum, MA (reprint author), Case Western Reserve Univ, Ctr Med Mycol, 11100 Euclid Ave,LKS 5028, Cleveland, OH 44106 USA |
Addresses:
1. Case Western Reserve Univ, Ctr Med Mycol, Cleveland, OH 44106 USA
2. Univ Hosp Cleveland, Dept Dermatol, Mycol Reference Lab, Cleveland, OH 44106 USA
3. Univ Hosp Cleveland, Dept Med, Div Infect Dis, Cleveland, OH 44106 USA |
| Publisher: I HOLZAPFEL VERLAG GMBH, RAUCHSTR 8, D-81679 MUNICH, GERMANY |
| Subject Category: Medicine, Research & Experimental |
| IDS Number: 563EH |
| ISSN: 0949-2321 |
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| | | | | | | | | Record from Web of Science® | | | | | | | | | |