Antifungal agent — voriconazole
Opportunistic fungal infections, particularly by Candida, Aspergillus and Cryptococcus organisms, are a major cause of death from infectious organisms. The rise in immunocompromised patients because of HIV infection has led to a concomitant rise in mortality from fungal infections.
The introduction of the triazole antifungal drugs revolutionised the treatment of fungal infections. However, there is still only a limited number of treatment options, and those that are available often have only a very narrow spectrum of activity and can have significant interaction problems with other drugs.
A new triazole antifungal agent, voriconazole, formerly known as UK-109,496, is being investigated for the treatment of fungal infections.1 Initial studies showed it to be of clinical use in the treatment of oropharyngeal and oesophageal candidiasis, and invasive aspergillosis in severly immunocompromised patients, notably those with advanced HIV infection. Of note is its activity against aspergillosis infections in immunocompromised patients who did not respond to amphotericin B. Similarly good responses were seen in patients with fluconazole-refractory oesophageal candidiasis, when treated with 200mg voriconazole orally twice daily.2
Other studies have shown voriconazole to have promise in the treatment of a number of other fungal infections whose current treatment options are limited. these include fusariosis and cryptococcosis.3,4
Trials indicate that voriconazole has few side-effects, although interactions with cytochrome P450-mediated drugs are likely because of its hepatic metabolism. Further studies are under way to clarify whether it will become a useful further weapon against fungal infections.