Table 1.

Antifungal agents currently available, mechanism of action, principle indications, and dosing schedule.

Class	Agents	Indication	Dosing schedule
Polyenes		Polyenes bind to sterols, preferentially to the primary fungal cell membrane sterol, and ergosterol. This binding disrupts osmotic integrity of the fungal membrane
	(1) Amphotericin B	Invasive fungal infections include: aspergillosis, cryptococcosis, North American blastomycosis, systemic candidiasis, coccidioidomycosis, histoplasmosis, zygomycosis, Conidiobolus, Basidiobolus, sporotrichosis	0.3–1.5 mg/kg
	(2) AmBisome	Empirical therapy in febrile neutropenic pts.	3 mg/kg/day
		Cryptococcal meningitis in HIV pts.	6 mg/kg/day
		Visceral leishmaniasis	3-4 mg/kg/day
	(3) Amphotericin B Colloidal dispersion (ABCD)	No primary indication; only salvage therapy	3–6 mg/kg
	(4) Abelcet (ABLC)	No primary indication only salvage	5 mg/kg
Azoles		Azoles inhibit cytochrome P450 14a demethylase (P45014DM) required for ergosterol synthesis
	(1) Voriconazole	Invasive aspergillosis and candidemia in nonneutropenic patients	6 mg/kg IV twice a day on day 1, then 4 mg/kg twice at day or 200 mg PO twice a day
		Esophageal candidiasis	200 mg PO twice a day given 1 hour before or after a meal
	(2) Fluconazole	Prophylaxis in transplant pts, invasive candida infections	800 mg/day IV on day 1, then 400 mg/day
		Oropharyngeal and esophageal candidiasis	200 mg/day IV or PO on day 1, then 100 mg/day
		Cryptococcal meningitis	200 up to 400 mg/day IV or PO
	(3) Itraconazole	Empirical therapy in febrile neutropenic patients, blastomycosis, pulmonary and extrapulmonary, histoplasmosis, chronic pulmonary and disseminated, and nonmeningeal histoplasmosis	200 mg IV twice a day or 100–400 mg po
	(4) Posaconazole	Prophylaxis of invasive Aspergillus and Candida in immunocompromised patients	200 mg (5 mL) three times a day with a full meal or nutritional supplement
		Oropharyngeal candidiasis	100 mg (2.5 mL) twice a day on day 1, then 100 mg (2.5 mL) once a day with a full meal or nutritional supplement
Echinocandins		The glucan synthesis inhibitors block fungal cell wall synthesis by inhibiting the enzyme 1,3-beta glucan synthase
	(1) Anidulafungin	Candidemia, acute disseminated candidiasis	200 mg/day on day 1 then 100 mg/day
		Esophageal candidiasis	100 mg on day 1, then 50 mg/day
	(2) Caspofungin	Candidemia, acute disseminated candidiasis, empirical therapy in febrile neutropenic patients, and invasive aspergillus refractory to other therapies	70 mg/day on day 1, then 50 mg/day
		Esophageal candidiasis	50 mg/day
	(3) Micafungin	Candidemia, acute disseminated candidiasis	100 mg/day
		Esophageal candidiasis	150 mg/day
		Prophylaxis of Candida infection in pt undergoing HSCT	50 mg/day