Received: 25.12.2025
Accepted: 21.04.2026
Published online: 29.04.2026
УДК: 615.03:615.281.8:616.992-085
DOI: 10.53511/pharmkaz.2026.2.2
MODERN APPROACHES TO ANTIMYCOTIC THERAPY FOR RESISTANT FUNGAL
INFECTIONS: A CLINICAL AND PHARMACOLOGICAL ANALYSIS OF NOVEL AGENTS
AND PK/PD-BASED STRATEGIES
Ospanova Akmaral Myktbekovna¹,
Ysraiyl Aigerim Auelbekovna¹,
Rakhmanberdieva Aizere Nurlybekovna¹,
Toilybay Ulzhan Kairatovna¹,
Kurbanova Bagila Moldiyarkyzy¹,
Khashimov Khusan Shavkatovich¹,
Ubaev Doniyor Abdukhapparovich¹
¹ Khoja Akhmet Yassawi International Kazakh-Turkish University, Faculty of Higher Medical Postgraduate Education, Department of Infectious Diseases and Phthisiology, Turkestan, Kazakhstan
Introduction. The increasing resistance of dermatophytes and yeast fungi to azoles and allylamines necessitates a pharmacokinetically justified choice of antifungal therapy.
Aim. To conduct a systematic analysis of modern antifungal drugs (including new molecules and systemic agents), evaluating their pharmacokinetic parameters and their potential for use in dermatomycosis amidst increasing resistance.
Materials and Methods. A structured systematic literature search was conducted in PubMed, Scopus, and Web of Science databases (2020-2025) using elements of the PRISMA 2020 protocol. The search strategy employed MeSH terms, keywords, and Boolean operators. The methodological quality of the 27 included sources was assessed using RoB 2 and AMSTAR-2 according to study design.
Results. The efficacy of azoles correlates with AUC/MIC ≥25, while echinocandins correlate with Cmax/MIC. New drugs (ibrexafungerp, rezafungin, olorofim) demonstrate activity against strains with cross-resistance. High lipophilicity and keratin penetration determine the effectiveness of onychomycosis therapy.
Discussion. The findings indicate that the use of new antifungal molecules in cutaneous mycoses should be interpreted cautiously, as part of the evidence is derived from studies of systemic and invasive fungal infections. Nevertheless, a PK/PD-oriented approach, susceptibility testing, and consideration of regional resistance patterns may improve the rationale for selecting antifungal therapy.
Conclusions. Optimization of therapy for cutaneous mycoses may be associated with broader use of a PK/PD-oriented strategy and gradual integration of molecular diagnostics into clinical practice.
Keywords: cutaneous mycoses, clinical pharmacology, antifungals, PK/PD, resistance, Phase III.
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