NCBI Bookshelf. Baron S, editor. Medical Microbiology. Dennis M. Dixon and Thomas J. An antifungal agent is a drug that selectively eliminates fungal pathogens from a host with minimal toxicity to the host. Amphotericin, nystatin, and pimaricin interact with sterols in the cell membrane ergosterol in fungi, cholesterol in humans to form channels through which small molecules leak from the inside of the fungal cell to the outside.
Note that this may not provide an exact translation in all languages. Oral antifungal drugs currently in use include itraconazole, fluconazole, ketoconazole and terbinafine. They are reserved for extensive or severe infection for which topical antifungal agents are inappropriate or ineffective, because of high cost, potential side effects and drug interactions. Griseofulvin is not discussed as it is no longer available in New Zealand. Nor is nystatin, as it is only appropriate for intestinal candidiasis. Voriconazole has recently become available but is reserve for the treatment of serious and refractory fungal infections in hospitalised patients. It should be taken after a fatty meal, preferably with an acidic drink such as orange juice.
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The four main classes of antifungal drugs are the polyenes, azoles, allylamines and echinocandins. Voriconazole and posaconazole have broad-spectrum activity against yeasts and moulds, including Aspergillus species. Posaconazole is the only azole drug with activity against zygomycete fungi. Caspofungin and the other echinocandins are effective in treating Candida and Aspergillus infections. The azoles are relatively safe, but clinicians should be aware of drug—drug interactions and adverse effects, including visual disturbances with voriconazole, elevations in liver transaminase levels, and skin rashes. Caspofungin has minimal adverse effects. Combination antifungal therapy may be appropriate in selected patients with invasive fungal infections, but is empiric and driven by individual physician practice. A fter a long period following the release of the first triazole antifungal agents fluconazole and itraconazole, in the early s and lipid amphotericin B AMB formulations mid s, several new antifungal drugs have become available.