Numerous progresses are realized in the
chemotherapy of
mycoses, particularly in the field of deep
mycoses due to 3 categories of systemic
antifungal agents:
polyenes (oral
nystatin, oral and intravenous
amphotericin B),
5-fluorocytosine (oral and intravenous) and
imidazole derivatives (oral and intravenous
miconazole, oral
ketoconazole). The old drugs as
nystatin and
amphotericin B per os continue to have a remarkable effect in oro-pharyngeal candidosis, chiefly after sufficient local contact with the mucos membranes; topical preparation are effective in fungal O.R.L. localizations (aspergillar or candidal
otomycoses,
glossitis). IV
amphotericin B is indicated in naso-orbital-cerebral mucor mycosis, nasosinusal
aspergillosis, candidosis, entomophthoromycoses and particularly systemic
mycoses (
histoplasmosis,
blastomycosis,
coccidioidomycosis) in spite of severe toxicity.
5-fluorocytosine (100-200 mg/kg) has a limited spectrum to Candida, Cryptococcus neoformans, Aspergillus fumigatus
infections if the strains are sensitive to this agent (5% primary resistance). Among the new
imidazole derivatives,
ketoconazole (400 mg/day) represent a revolutionary
antifungal agent due to a very large antifungal spectrum, absence of toxicity, rapid diffusion by oral way, and high therapeutic efficiency in candidosis,
histoplasmosis,
blastomycosis, rhino-
entomophthoromycosis... Oral
miconazole has a poor diffusion into the tissues and by intravenous way necessitates several
injections daily to obtain therapeutic levels. Numerous
imidazole derivatives (
econazole,
miconazole,
clotrimazole etc...) can be successfully utilized by topical application, as well as numerous other local
antifungal agents.