Chen Sharon C A, Sorrell Tania C
Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia.
Med J Aust. 2007 Oct 1;187(7):404-9. doi: 10.5694/j.1326-5377.2007.tb01313.x.
The four main classes of antifungal drugs are the polyenes, azoles, allylamines and echinocandins. Clinically useful "older" agents include topical azole formulations (for superficial yeast and dermatophyte infections), first-generation triazoles (fluconazole and itraconazole, for a range of superficial and invasive fungal infections), amphotericin B formulations (for a broad range of invasive fungal infections) and terbinafine (for dermatophyte infections). Clinically important "newer" agents include members of the echinocandin class (eg, caspofungin) and second-generation triazoles (eg, voriconazole and posaconazole). Voriconazole and posaconazole have broad-spectrum activity against yeasts and moulds, including Aspergillus species. Posaconazole is the only azole drug with activity against zygomycete fungi. Caspofungin and the other echinocandins are effective in treating Candida and Aspergillus infections. The azoles are relatively safe, but clinicians should be aware of drug-drug interactions and adverse effects, including visual disturbances (with voriconazole), elevations in liver transaminase levels, and skin rashes. Caspofungin has minimal adverse effects. Combination antifungal therapy may be appropriate in selected patients with invasive fungal infections, but is empiric and driven by individual physician practice.
抗真菌药物的四大主要类别为多烯类、唑类、烯丙胺类和棘白菌素类。临床上常用的“老药”包括外用唑类制剂（用于浅表酵母菌和皮肤癣菌感染）、第一代三唑类药物（氟康唑和伊曲康唑，用于一系列浅表和侵袭性真菌感染）、两性霉素B制剂（用于多种侵袭性真菌感染）以及特比萘芬（用于皮肤癣菌感染）。临床上重要的“新药”包括棘白菌素类成员（如卡泊芬净）和第二代三唑类药物（如伏立康唑和泊沙康唑）。伏立康唑和泊沙康唑对酵母菌和霉菌具有广谱活性，包括曲霉菌属。泊沙康唑是唯一对接合菌纲真菌有活性的唑类药物。卡泊芬净和其他棘白菌素类药物对治疗念珠菌和曲霉菌感染有效。唑类药物相对安全，但临床医生应注意药物相互作用和不良反应，包括视觉障碍（与伏立康唑有关）、肝转氨酶水平升高和皮疹。卡泊芬净的不良反应极小。联合抗真菌治疗可能适用于某些侵袭性真菌感染患者，但这是经验性的，且由个体医生的实践决定。
