infections such as the central nervous system or the necrotic tissue with poor blood supply; (vi) reduced blood concentration of the antifungal agent due to drug interaction, especially during voriconazole therapy; (vii) suboptimal duration of the antifungal therapy; and (viii) the underlying disease as the main barometer of clinical success and failure in antifungal therapy.
Like bacteria, fungi also produce a biofilm in vitro. It is well known that the biofilm is an important obstruction in antibacterial therapy. In fungal infections similar studies have been conducted. Enhanced extracellular matrix especially beta glucan synthesis during biofilm growth has been shown to prevent penetration of antifungal agents such as azole and polyene29. It is believed that the echinocandins and lipid formulations of amphotericin B can penetrate biofilm better than amphotericin B deoxycholate and azoles19. The clinical trials also indicate the importance of the biofilm. Numerous clinical trials on candidemia have demonstrated that the treatment failure and mortality are high in patients who are on catheters for long periods.