:
Pulmonary mycoses are associated with high morbidity and mortality. The current standard treatment by
systemic administration is limited by inadequate local bioavailability and systemic toxic effects. Aerosolisation of
antifungals is an attractive approach to overcome these problems, but no inhaled antifungal formulation is currently
available for the treatment of pulmonary mycoses. Hence, the development of respirable antifungals formulations is of
interest and in high demand. In this review, the recent advances in the development of antifungal formulations for
pulmonary delivery are discussed, including both nebulised and dry powder formulations. Although the clinical practices
of nebulised parenteral amphotericin B and voriconazole formulations (off-label use) are reported to show promising
therapeutic effects with few adverse effects, there is no consensus about the dosage regimen (e.g. the dose, frequency, and
whether they are used as single or combination therapy). To maximise the benefits of nebulised antifungal therapy, it is
important to establish standardised protocol that clearly defines the dose and specifies the device and the administration
conditions. Dry powder formulations of antifungal agents such as itraconazole and voriconazole with favourable
physicochemical and aerosol properties are developed using various powder engineering technologies, but it is important
to consider their suitability for use in patients with compromised lung functions. In addition, more biological studies on
the therapeutic efficacy and pharmacokinetic profile are needed to demonstrate their clinical potential.
Naturally Occurring Antifungal Agents and Their Modes of Action
