Overview of oral azole drugs as systemic antifungal therapy

Over the past 15 years, oral azole drugs have been increasingly utilized as alternatives to amphotericin B for the therapy of many common systemic fungal infections. In general, the azoles, especially the triazoles (itraconazole and fiuconazole) are better tolerated and more effective than the imidazoles (miconazole and ketoconazole). Two areas of potential limitations are the frequent interactions of azoles with coadministered drugs, resulting in adverse clinical consequences, and the emerging problem of microbiologic and clinical resistance, especially to fluconazole. Here, the azoles will be reviewed with regard to mechanism of action, pharmacology, toxicity and drug interaction profiles, clinical indications, role in prophylaxis, and concerns about resistance.