Pharmacokinetic considerations for the use of newer antifungal agents

Endogenous commensal yeast and saprophytic molds remain important causes of morbidity and mortality in immunocompromised patients. Treatment options for patients with serious fungal infections have improved over the past decade with the introduction of a novel class of antifungals that target the fungal cell wall (echinocandins) and a new generation of broader-spectrum triazoles (voriconazole, posaconazole). Although these newer therapies provide a number of important advantages in terms of spectrum and safety, their efficacy in some patients can be compromised by limited penetration into some sites of infection or by variable serum concentrations. Hence, pharmacokinetic considerations have become increasingly important for the effective use of these newer antifungals. This article provides a brief overview of the pharmacology and important pharmacokinetic considerations of systemic antifungal therapies, with special focus on newer triazoles and echinocandins.