Amphotericin B
Drug class
Polyene macrolide
Amphotericin B
Mechanism
Pores are formed in the fungal cell membrane, allowing leakage of K+ and Mg+
Amphotericin B
Uses
Life-threatening invasive fungal infections; broad antifungal spectrum; (occasionally used with flucytosine in immunocompromised hosts)
Lipid formulations result in better tolerability
Amphotericin B
Side effects
Chronic: fall in renal function (may only be partially reversible); K+ Mg+ wasting; renal tubular acidosis
Acute during IV infusion: fever/chillls; potential for hypotension;
Nystatin
Drug class
Polyene macrolide
Nystatin
Mechanism
Pores are formed in the fungal cell membrane, allowing leakage of K+ and Mg+
Nystatin
Uses
Topically (powder) against superficial fungal infections (candidiasis only)
No use against dermatophytes
Fluconazole
Drug class
Triazole / Cell membrane synthesis inhibitor
Fluconazole
Mechanism
Inhibit ergosterol synthesis by inhibiting lanosterol demethylase
Fluconazole
Uses
Candida infections; secondary treatment and prophylaxis of cryptococcal meningitis
Clotrimazole = topical; fluconazole = systemic
Fluconazole
Side effects
Hepatotoxicity (rarely), GI side effects, inhibits CYP450
Voriconazole; Itraconazole
Drug class
Triazole / Cell membrane synthesis inhibitor
Voriconazole; Itraconazole
Mechanism
Inhibit ergosterol synthesis by inhibiting lanosterol demethylase
Voriconazole; Itraconazole
Uses
Candida & Aspergillus infections
Voriconazole; Itraconazole
Side effects
Hepatotoxicity (rarely), GI side effects, inhibits CYP450
Visual disturbances w/ voriconazole
Posaconazole
Drug class
Triazole / Cell membrane synthesis inhibitor
Posaconazole
Mechanism
Inhibit ergosterol synthesis by inhibiting lanosterol demethylase
Posaconazole
Uses
Candida, Fusarium, Mucorales infections
Posaconazole
Side effects
Hepatotoxicity (rarely), GI side effects, inhibits CYP450
Efinazonazole (Jublia)
Drug class
Azole / Cell membrane synthesis inhibitor
Efinazonazole (Jublia)
Mechanism
Inhibit ergosterol synthesis by inhibiting lanosterol demethylase
Efinazonazole (Jublia)
Uses
Candida; Tinea
Efinazonazole (Jublia)
Side effects
Application site dermatitis, pain
Tolnaftate; Terbinafine
Drug class
Allylamine / Cell wall synthesis inhibitor
Tolnaftate; Terbinafine
Mechanism
Inhibit ergosterol synthesis by inhibiting squalene epoxidase
Tolnaftate; Terbinafine
Uses
Topical dermatophytes (limited utility against candida)
Terbinafine effective against onychomycoses; tolnaftate: oral only; weak agent
Tolnaftate; Terbinafine
Side effects
Hepatotoxicity (rarely)
Low side effect profile
Capsofungin; Micafungin; Anidulafungin
Drug class
Echinocandin / Cell wall synthesis inhibitor
Capsofungin; Micafungin; Anidulafungin
Mechanism
Inhibit synthesis of Beta(1,3)-D-glucan, an essential component of the fungal cell wall
Capsofungin; Micafungin; Anidulafungin
Uses
Life-threatening fungal infections unresponsive to older agents (especially candida, aspergillus)
Capsofungin; Micafungin; Anidulafungin
Side effects
Low side effect profile
Expensive; only available as IV formulation
Flucytosine
Drug class
Nucleic acid synthesis inhibitor
Flucytosine
Mechanism
Prodrug converted by fungal enzyme to analog inhibitor of pyrimidine nucleotide synthesis
Flucytosine
Uses
Used in combo with amphotericin B in life threatening fungal infections in immunocompromised patients.
Flucytosine
Side effects
Bone marrow toxicity; Liver dysfunction possible