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Fungal infections are usually more difficult to treat than bacterial infections, because fungal organisms grow slowly and because fungal infections often occur in tissues that are poorly penetrated by antimicrobial agents (e.g., devitalized or avascular tissues). Therapy of fungal infections usually requires prolonged treatment. Potentially life-threatening infections caused by dimorphic fungi are becoming more common because increasing numbers of immunocompromised patients are seen in clinical practice; AIDS, organ and bone marrow transplantation, and illnesses associated with neutropenia all predispose individuals to invasive fungal infection.

Superficial fungal infections involve cutaneous surfaces, such as the skin, nails, and hair, and mucous membrane surfaces, such as the oropharynx and vagina. A growing number of topical and systemic agents are available for the treatment of these infections. Deep-

seated or disseminated fungal infections caused by dimorphic fungi, the yeasts Cryptococcus neoformans, and various Candida spp. respond to a limited number of systemic agents: amphotericin B desoxycholate (a polyene), amphotericin B liposomal preparations, flucyto-sine (a pyrimidine antimetabolite), the newer azoles, including ketoconazole, fluconazole, itraconazole and voriconazole, and capsofungin (an echinocandin).

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