Pharmacy World and Science

, Volume 27, Issue 1, pp 31–34 | Cite as

Antifungal drugs and rational use of antifungals in treating invasive aspergillosis: the role of the hospital pharmacist

  • Tiene G. M BautersEmail author
  • Franky M. A. Buyle
  • Renaat Peleman
  • Hugo Robays


Aim:This review discusses the most common used antifungal agents in the treatment of invasive fungal infections. In addition, guidelines for the treatment of invasive aspergillosis, as used in the Ghent University Hospital, are described. Moreover, the importance of determining the effectiveness of antifungal therapy as well as the potential role of the hospital pharmacist in the management of this infection is highlighted.

Methods:A review of the English-language literature was conducted using the MEDLINE database and scientific websites. Search terms including antimycotics, antifungal therapy and invasive aspergillosis were used to refine the search, and preference was given to studies published after 1992. This was completed with recent treatment guidelines.

Results:An overview of the most recent advances in antifungal therapy is described. In addition, a flowchart for treatment of invasive aspergillosis (proven, probable or possible) has been developed.

Conclusion:Invasive fungal infections will remain a frequent and important complication of modern medicine. Considering the clinical and financial outcome of invasive fungal infections, the role of the hospital pharmacist can be a paramount to the treatment.


Antifungal agents Aspergillosis Formulary management Guidelines Hospital pharmacist  


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Mossad, S 2003Prevention and treatment of fungal infections in bone marrow transplantation.Curr Hematol Rep23029PubMedGoogle Scholar
  2. Sanglard D, Bille J. Current understanding of the modes of action of and resistance mechanisms to conventional and emerging antifungal agents for treatment of Candida infections. In: Calderone R, editor. Washington, USA: ASM Press, 2002. Google Scholar
  3. Groll, AH, Walsh, TJ 2002Antifungal chemotherapy: advances and perspectives.Swiss Med Weekly13230311Google Scholar
  4. Prevention, diagnosis and management of invasive aspergillosis in immunocompromised patients. The Infectious Diseases Advisory Board, 2004. ISBN 90-805936-4-8.Google Scholar
  5. Meyer, RD 1992Current role of therapy with amphotericin B.Clin Infect Dis14(Suppl.1)S154S160Google Scholar
  6. liposomal.htm.Google Scholar
  7. Lyman, CA, Walsh, TJ 1992Systemically administered antifungal agents. A review of their clinical pharmacology and therapeutic applications.Drugs44935PubMedGoogle Scholar
  8. Anaissie, EJ, Kontonyiannis, DP, Huls, C, Vartivarian, SE, Karl, C, Prince, RA, Bosso, J, Bodey, GP 1995Safety, plasma concentrations, and efficacy of high-dose fluconazole in invasive mold infections.J Infect Dis172599602PubMedGoogle Scholar
  9. Wheat, J, MaWhinney, S, Hafner, R, McKinsey, D, Chen, D, Korzun, A,  et al. 1997National institute of allergy and infectious diseases acquired immunodeficiency syndrome clinical trials group and mycoses study group. Treatment of histoplasmosis with fluconazole in patients with acquired immunodeficiency syndrome.Am J Med10322332CrossRefPubMedGoogle Scholar
  10. Pappas, PG, Bradsher, RW, Kauffman, CA, Cloud, GA, Thomas, CJ, Campbell, GD,  et al. 1997National institute of allergy and infectious diseases mycoses study group. Treatment of blastomycosis with higher doses of fluconazole.Clin Infect Dis25200205PubMedGoogle Scholar
  11. Vandewoude, K, Vogelaers, D, Decruyenaere, J, Jaqmin, P, De Beule, K, Peer, A,  et al. 1997Concentrations in plasma and safety of 7 days of intravenous itraconazole followed by 2 weeks of oral itraconazole solution in patients in intensive care units.Antimicrob Agents Chemother4127148PubMedGoogle Scholar
  12. Zhou, HH, Goldman, M, Wu, J, Woestenborghs, R, Hassell, AE, Lee, P,  et al. 1998A pharmacokinetic study of intravenous itraconazole followed by oral administration of itraconazole capsules in patients with advanced human immunodeficiency virus infection.J Clin Pharmacol38593602PubMedGoogle Scholar
  13. Sheehan, DJ, Hitchcock, CA, Sibley, CM 1999Current and emerging azole antifungal agents.Clin Microbiol Rev124079PubMedGoogle Scholar
  14. Law, D, Moore, CB, Denning, DW 1997Activity of SCH 56592 compared with those of fluconazole and itraconazole against Candida spp.Antimicrob Agents Chemother41231011PubMedGoogle Scholar
  15. Scholar
  16. Odds, FC, Brown, AJP, Gow, NAR 2003Antifungal agents: mechanisms of action.Trends Microbiol1127279CrossRefPubMedGoogle Scholar
  17. Denning, D 2002Echinocandins: a new class of antifungals.J Antimicrob Chemother4988991CrossRefPubMedGoogle Scholar
  18. Denning, D 1997Echinocandins and pneumocandins: a new antifungal class with a novel mode of action.J Antimicrob Chemoth4061114CrossRefGoogle Scholar
  19. Wiederhold, N, Lewis, R 2003The echinocandin antifungals: an overview of the pharmacology, spectrum and clinical efficacy.Expert Opin Drugs12131333CrossRefGoogle Scholar
  20. Andes, D, Ogtrop, M 2000In vivo characterization of the pharmacodynamics of fIucytosine in a neutropenic murine disseminated candidiasis model.Antimicrob Agents Chemother4493842CrossRefPubMedGoogle Scholar
  21. Scholar
  22. Wetzstein, GA 2000Intravenous to oral (IV:PO) anti-infective conversion therapy.Cancer Control71706PubMedGoogle Scholar
  23. Nathwani, D, Tillotson, G, Davey, P 1997Sequential antimicrobial therapy, the role of quinolones.J Antimicrob Chemother394416CrossRefPubMedGoogle Scholar
  24. Von Gunten , V, Amos, V, Sidler, A, Beney, J, Troillet, N, Reymond, J 2003Hospital pharmacists’ reinforcement of guidelines for switching from parenteral to oral antibiotics: a pilot study.Pharm World Sci25525CrossRefPubMedGoogle Scholar
  25. Lazarus, HM, Blumer, JL, Yanovich, S, Schlamm, H, Romero, A 2002Safety and pharmacokinetics of oral voriconazole in patients at risk of fungal infection: a dose escalation study.J Clin Pharmacol42395402CrossRefPubMedGoogle Scholar
  26. Laing, RB, Mackenzie, AR, Shaw, H, Gould, IM, Douglas, JG 1998The effect of intravenous-to-oral switch guidelines on the use of parenteral on use antimicrobials in medical wards.J Antimicrob Chemother4210711CrossRefPubMedGoogle Scholar
  27. Somers, A, Bauters, T, Robays, H, Bogaert, M, Colardyn, F 2002Evaluation of human albumin use in a university hospital in Belgium.Pharm World Sci241116CrossRefPubMedGoogle Scholar
  28. Nathwani, D, Gray, K, Borland, H 2002Quality indicators for antibiotic control programmes.J Hosp Infect501659CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Tiene G. M Bauters
    • 1
    Email author
  • Franky M. A. Buyle
    • 1
  • Renaat Peleman
    • 2
  • Hugo Robays
    • 1
  1. 1.Department of PharmacyGhent University HospitalGhentBelgium
  2. 2.Department of Internal Medicine, Division of Infectious DiseasesGhent University HospitalGhentBelgium

Personalised recommendations