Antifungals

• Classification of fungal infections

  • Superficial fungal infections
  • Deep fungal infections
• Superficial fungal infections


  • Dermatophytes
  • Candida
• Types of Dermatophytes


  • Tinea capitis
  • Tinea corporis
  • Tinea unguium
  • Tinea cruris
  • Tinea pedis
• Types of Candida infections

  • Cutaneous
  • Vaginal
  • Oropharyngeal
  • Gastrointestinal Candidiasis
• Deep fungal infections


  • Pneumonia
  • Gastro-enteritis
  • Endocarditis
  • Meningitis
• Azoles


  • Inhibition of Ergosterol synthesis
  • Inhibits cytochrome P450 isoenzyme
• Azole antifungal drugs


  • Ketoconazole
  • Fluconazole
  • Itraconazole
  • Miconazole
• Ketoconazole


  Indicated in deep fungal infections, Candida, and dermatophytes
• Ketoconazole decreases steroid synthesis which depends on cytochrome P450
• Ketoconazole increases blood level of oral anticoagulants, anti-epileptics, and oral hypoglycemic drugs leading to their toxicity
• Fluconazole and Itraconazole


  • More specific to fungal P450 than to human cytochrome P450
  • Less toxic
  • More effective
  • Better absorption
• Fluconazole reaches CSF, therefore could be given in fungal meningitis
• Fluconazole is a single dose, therefore increases patient compliance
• Polyene antifungals


  • Binds to Ergosterol of fungal cell membrane
  • Leads to formation of artificial pores
• Polyene antifungals


  • Amphotericin B
  • Nystatin
• Amphotericin B


  Most important anti-fungal in deep infections
• Nystatin


  Acts locally; too toxic for systemic use
• Griseofulvin


  Interferes with microtubule function and inhibits nucleic acid synthesis
• Griseofulvin is an enzyme inducer leading to decreased Warfarin level
• Terbinafine


  Inhibition of Squalene epoxidase enzyme essential for Ergosterol synthesis
• Terbinafine


  • No inhibition of cytochrome P450
  • Indicated for dermatophytes
• Flucytosine


  Cytotoxic drug transformed in fungus to 5-fluro-uracil
• Combination of Flucytosine and Amphotericin-B


  • Decreases resistance to Flucytosine
  • Decreases nephrotoxicity of Amphotericin
• Drugs for superficial infections

  • Nystatin
  • Azoles
  • Terbinafine
• Drugs given systematically for superficial infections

  • Griseofulvin
  • Terbinafine
  • Azoles
• Drugs for systemic fungal infections

  • Amphotericin-B
  • Flucytosine
  • Azoles