Antifungal Agents and Their Role in the Management of Pulmonary Aspergillosis

Of the three main classes of systemic antifungals available for clinical use, the azoles, specifically the extended-spectrum triazoles voriconazole, posaconazole, and isavuconazole, have been established as frontline agents for most forms of aspergillosis, owing to their superior efficacy in controlled clinical trials and overall favorable safety profiles. However, the use of these drugs may nevertheless be constrained by emerging resistance among Aspergillus species, as well as potential toxicity and drug–drug interactions. Echinocandins and lipid formulations of amphotericin B are currently reserved for patients who are intolerant or refractory to the extended triazoles. This chapter discusses the in vitro activities, pharmacokinetic and pharmacodynamic characteristics, and adverse effects of these drugs, along with key findings from clinical trials of pulmonary aspergillosis.