Table 1.
US Food and Drug Administration-approved indication of antifungal agents for the management of IFIs
| Indication | Echinocandins | Newer azoles | Polyenes | ||||||
|---|---|---|---|---|---|---|---|---|---|
| CAS | MICA | ANID | VOR | POS | AmB-D | ABLC | ABCD | L-AmB | |
| Empiric treatment of invasive fungal infections | YES | YES | |||||||
| Prophylaxis of Candida infections | YES§ | YES* | |||||||
| Prophylaxis of invasive aspergillosis | YES* | ||||||||
| Target therapy of invasive aspergillosis | YES | YES | YES† | YES++ | YES‡ | YES○ | |||
| Target therapy of mucormycosis | YES† | YES++ | |||||||
| Salvage treatment of IFIs | YES• | YES++ | |||||||
| Oropharyngeal candidiasis | YES | YES | YES | YES | YES++ | YES○ | |||
| Invasive candidiasis | YES | YES | YES | YES•• | YES† | YES++ | YES○ | ||
Notes: In patients aged ≥13 years, who are at high risk of developing these infections due to being severely immunocompromised, such as hematopoietic stem-cell transplant recipients with graft versus host disease or those with hematologic malignancies with prolonged neutropenia from chemotherapy;
in patients undergoing allogeneic hematopoietic stem-cell transplant;
infections with Scedosporium spp and Fusarium spp in patients refractory to or intolerant of other agents.
in nonneutropenic patients.
AmB-D is approved for the treatment of potentially life-threatening fungal infections: aspergillosis; cryptococcosis (torulosis); North American blasmomycosis; systemic candidiasis; coccidioidomycosis; histoplasmosis; and zgomycosis including mucormycosis due to susceptible species of the genera Absidia, Mucor, and Rhizopus and infections due to related susceptible species of Conidiobolus and Basidiobolus, and sporotrichosis;
ABLC approved for the treatment of invasive fungal infections in patients who are refractory to or intolerant of conventional amphotericin B;
ABCD is approved for the treatment of invasive aspergillosis in patients who are refractory to or intolerant of conventional amphotericin B;
L-AmB (AmBisome) is approved for the treatment of patients with Aspergillus spp, Candida spp, and/or infections due to Cryptococcus spp refractory to conventional AmB or in patients with marked renal impairment or when severe toxicity precludes the use of conventional AmB; also approved for the treatment of cryptococcal meningitis in human immunodeficiency virus–infected patients and visceral leishmaniasis.
Abbreviations: ABCD, amphotericin B colloidal dispersion; AmB-D, amphotericin B deoxycolate; ABLC, amphotericin B lipid complex; ANID, anidulafungin; CAS, caspofungin; IFIs, invasive fungal infections; L-AmB, liposomal amphotericin B; MICA, micafungin; POS, posaconazole; VOR, voriconazole.