Antifungal and antiviral

• Fungi are found in soil, air, and contaminated food
• Flucytosine is a nucleic acid analog antimetabolite used for systemic fungal infections with adverse effects like bone marrow suppression, jaundice, abdominal bloating, GI hemorrhage, nausea, vomiting, and ulcerative colitis
• Types of fungal infections

  • Systemic - Throughout the body
  • Dermatophytic - Hair, skin, and nails
  • Candida - Skin and mucous membranes
• Systemic fungal infections are common in hospitals, especially in neutropenic patients and those immunocompromised by HIV
• Amphotericin B is a broad-spectrum fungicide used for the treatment of systemic fungal infections with adverse effects like chills, fever, muscle spasm, headache, vomiting, and hypotension
• Candida infections include vaginal yeast infections (moniliasis) and can thrive in the mouth, pharynx, esophagus, GI tract, and urinary bladder. Thrush is a Candida infection of the mouth or pharynx
• Mycoses are infections or diseases caused by a fungus
• Systemic fungal infections can infect blood, bones, and lungs and can be dangerous in chronically ill patients
• Antifungal drugs alter cell-wall synthesis, inhibit fungal DNA, and bind to the proteins that the fungus requires to survive
• Echinocandins have fungicidal activity against Candida species and are used for esophageal candidiasis and candidemia with adverse effects like chills, fever, headache, diarrhea, rash, and phlebitis
• Dermatophytic fungal infections infect hair, nails, and skin and are characterized by symptoms like itching, discolored and scaling skin, inflammation, blisters, and broken skin
• Azoles are systemic antifungal drugs
• Antimetabolite


  • Not used alone or as a first-line therapy because of frequent organism resistance
  • Adverse effects include bone marrow suppression, jaundice, abdominal bloating, GI hemorrhage, nausea, vomiting, and ulcerative colitis
• Adverse effects of Azoles

  • Fever
  • Rash
  • Nausea, vomiting, diarrhea
  • Headache
  • Hallucinations
• Oral and Topical Antifungal Drugs - Topical administration

  • Nystatin
  • Griseofulvin
  • Terbinafine
• Fluconazole is used for cryptococcal and coccidioidal meningitis
• H1N1 is a subtype of influenza type A virus known as swine or pig flu, affecting healthy young people more than those over 65
• Virus is a small infectious agent that must invade a living cell to reproduce
• Flu viruses primarily affect the upper and lower respiratory tracts and spread through sneezes and coughs of infected persons
• Terbinafine

  • Fungicidal activity
  • Used for the treatment of interdigital-type Tinea pedis (athlete’s foot), Tinea cruris (jock itch), and Tinea corporis (ringworm)
  • Well absorbed after oral administration
  • Adverse effects include diarrhea, dyspepsia, pruritus, taste disturbances, and urticaria
• Systemic Antifungal Drugs - Azoles

  • Ketoconazole
  • Fluconazole
  • Itraconazole
• Griseofulvin

  • Effective against fungal infections of keratinized tissues—hair, skin, and nails
  • Binds to keratin and prevents the fungi from utilizing the protein
  • Fungistatic - Does not kill fungi, just inhibits nutrient access
  • Food increases absorption
  • Higher the fat content, the better
• Antimetabolite is an acid analog
• Common viral diseases

  • Influenza
  • Chickenpox
  • Cold sores
  • Rabies
  • Mononucleosis
  • Pneumonia
  • AIDS
• Itraconazole is used to treat several types of fungal infections including histoplasmosis, paracoccidioidomycosis, blastomycosis, invasive aspergillosis, and fungal meningitis
• Contraindications for Intravaginal use

  • Drugs should not be given to patients with a sensitivity to any antifungal drug
  • Itraconazole and flucytosine should not be used by pregnant women as they have caused fetal damage in lab animals
• Topical administration

  1. Application to the surface of the skin or mucous membrane

  2. Useful in superficial fungal infection

  3. Safe during pregnancy
• Symptoms of influenza include headache, fever, intense fatigue, dry cough, muscle ache, and sensitivity to light
• Influenza outbreaks occur every year with different timings in the northern and southern hemispheres
• Viral Diseases

  • Swine or pig flu
  • New emergent influenza
• Influenza

  Symptoms occur 24 to 72 hours after infection and usually last only 7 to 14 days
• People over 65 least likely to be affected by H1N1
• HIV can exist in the body without any symptoms
• Women are more likely to become infected with AIDS now
• Most people die within 10 years of first symptoms of AIDS
• Herpes viruses


  • Herpes simplex
  • Herpes zoster
  • Cytomegalovirus
  • Epstein-Barr virus
  • Herpesvirus 6
  • Herpesvirus 7
  • Herpesvirus 8
• 40,000 new infections of AIDS occur in the United States every year
• Herpes zoster

  • Chickenpox
  • Shingles - Vaccine available to patients over 60
• There is no vaccine or acquired immunity from HIV
• Secondary bacterial infections

  • Otitis media
  • Bronchitis