Laboratory of Antifungal Chemotherapy, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
Mycoses. 2020 Oct;63(10):1047-1059. doi: 10.1111/myc.13157. Epub 2020 Sep 4.
Invasive fungal infections (IFIs) in the central nervous system (CNS) are particularly hard to treat and are associated with high morbidity and mortality rates. Four chemical classes of systemic antifungal agents are used for the treatment of IFIs (eg meningitis), including polyenes, triazoles, pyrimidine analogues and echinocandins. This review will address all of these classes and discuss their penetration and accumulation in the CNS. Treatment of fungal meningitis is based on the antifungal that shows good penetration and accumulation in the CNS. Pharmacokinetic data concerning the entry of antifungal agents into the intracranial compartments are faulty. This review will provide an overview of the ability of systemic antifungals to penetrate the CNS, based on previously published drug physicochemical properties and pharmacokinetic data, for evaluation of the most promising antifungal drugs for the treatment of fungal CNS infections. The studies selected and discussed in this review are from 1990 to 2019.
中枢神经系统（CNS）侵袭性真菌感染（IFI）尤其难以治疗，并且与高发病率和死亡率相关。有四类全身性抗真菌药物可用于治疗 IFI（例如脑膜炎），包括多烯类、三唑类、嘧啶类似物和棘白菌素类。本综述将讨论所有这些类别，并讨论它们在 CNS 中的穿透和积累。真菌性脑膜炎的治疗基于在 CNS 中具有良好穿透和积累的抗真菌药物。关于抗真菌药物进入颅内隔室的药代动力学数据存在缺陷。本综述将根据先前发表的药物物理化学性质和药代动力学数据，概述全身性抗真菌药物穿透 CNS 的能力，以评估最有希望的抗真菌药物治疗真菌性 CNS 感染。本综述中选择和讨论的研究来自 1990 年至 2019 年。
