Table 3.

Common antifungal agents, their mechanism, spectrum of activity, and toxicities

Class	Drugs	Yeast Activity	Mold Activity	Formulations	Toxicity
Triazolesa	Fluconazole	+++	None	IV/PO	Voriconazole and Posaconazole: hepatotoxicity, QT prolongationd Voriconazole: photosensitivity, skin cancer, fluorosis, CNS symptoms (delirium, hallucinations)
	Itraconazole	+++	+	PO
	Voriconazoleb	+++	+++c	IV/PO
	Posaconazoleb	+++	+++	IV/PO
	Isavuconazole	+++	+++	IV/PO
Echinocandinse	Micafungin Caspofungin	+++	++c	IV	Hepatotoxicity
Polyenes	Amphotericin B deoxycholate	+++	+++	IV	Nephrotoxicityf Infusion reactions
	Liposomal amphotericin B	+++	+++	IV

^aVoriconazole is approved for patients aged ≥2 years and posaconazole is approved for patients ≥13 years. Phase 1 trials for isavuconazole are ongoing (ClinicalTrials.gov: NCT 03241550)

^bTherapeutic drug monitoring is recommended for voriconazole and posaconazole

^cNo activity against Mucorales

^dIsavuconazole is associated with shortening of the QT interval

^eFor children, there are no relevant pharmacological differences between the echinocandins

^fLessened with liposomal formulation