Systemic antifungal agents

Systemic antifungal drugs used to treat serious fungal disease fall chiefly into three drug classes-azoles, echinocandins, and polyenes. A fourth class, pyrimidine analogues, consists of a single agent, flucytosine, that is only used in combination with other antifungals. Both azoles and polyenes target the cell membrane, while echinocandins specifically target cell wall synthesis. This chapter details drugs mechanisms of action, spectrum of activity, pharmacokinetics, and toxicities associated with the clinical use of currently approved systemic antifungals to treat life-threatening mycoses. In addition to drug characteristics, the detection and interpretation of antifungal resistance is discussed for common clinically relevant species.