TABLE 2.
Spectrum of activity of more commonly used systemic antifungal agents
| Selected fungal species |
Antifungal agents* |
||||
|---|---|---|---|---|---|
| Amphotericin B products | Fluconazole | Voriconazole | Posaconazole | Echinocandins | |
| Aspergillus fumigatus | ++ | − | +++ | +++ | ++ |
| Aspergillus terreus | − | − | +++ | +++ | ++ |
| Aspergillus flavus | ++ | − | +++ | +++ | ++ |
| Candida albicans | +++ | +++ | +++ | +++ | +++ |
| Candida glabrata | ++ | +/− | + | + | +++ |
| Candida lusitaniae | +/− | + | ++ | ++ | ++ |
| Candida tropicalis | +++ | +++ | +++ | +++ | +++ |
| Candida krusei | ++ | − | ++ | ++ | +++ |
| Candida parapsilosis | +++ | +++ | +++ | +++ | ++ |
| Candida guilliermondii | ++ | +++ | +++ | +++ | ++ |
| Cryptococcus neoformans | +++ | +++ | +++ | +++ | − |
| Fusarium species | ++ (applies to lipid products) | − | ++ | ++ | − |
| Scedosporium apiospermum | +/− | − | +++ | +++ | +/− |
| Scedosporium prolificans | +/− | − | +/− | +/− | − |
| Zygomycetes (eg, Absidia, Mucor, Rhizopus) | +++ (applies to lipid products) | − | − | +++ | − |
| Dematiaceous moulds† | + | +/− | +++ | +++ | + |
| Dimorphic fungi‡ | +++ | + | ++ | ++ | − |
| +++ Coccidioides | − Sporothrix | + Sporothrix | |||
| +/− Sporothrix | |||||
The above is based on in vitro activity, which does not always predict outcomes in clinical practice.
*
Flucytosine: Use only in combination therapy for Candida, Cryptococcus neoformans and selected dematiaceous moulds;
†
Dematiaceous moulds: Alternaria, Bipolaris, Curvularia, Exophiala;
‡
Dimorphic fungi: Blastomycetes dermatitidis, Coccidioides immitis/posadasii, Histoplasma capsulatum, Sporothrix schenckii. Itraconazole is a first-line therapy for dimorphic fungi. Adapted from reference 40