Anti Fungal Drugs

Tinea Pedis

Ringworm of the foot “athlete's foot”

Tinea Corporis

Ringworm of the body

Tinea Cruris

Ringworm of the groin “jock itch”

Tinea Capitis

Ringworm of the scalp

Oral Candidiasis

Thrush

Onychomycosis

Fungal infection of nails

Opportunistic Mycoses

Occur primarily in debilitated and/or immunocompromised patients (AIDS, leukemia, lymphoma)

Non-Opportunitistic (Endemic Mycoses)

D/t various pathogens distributed unevenly around the world, can occur in any host

Polyene Antibiotics

Amphotericin B + Nystatin

Polyene MOA

Binds to ergosterol in fungal cell membrane, creating pores that cause leakage of cellular contents l/t fungal cell death

Amphotericin B

Broad-spectrum antifungal agent, drug of choice for systemic mycoses, highly toxic fungistatic/fungicidal depending on pH

Amphotericin B Administration

Poorly from GI tract (oral therapy not effective), slow IV infusion over 2-6 hours everyday (can l/t infusion reactions)

Nystatin

Treats superficial mycoses, candidal infections of mucosa, skin, intestinal tract and vagina

Topical Nystatin

Remains drug of choice for treatment of candidal infections of the oral cavity (thrush, oral moniliasis, denture stomatitis) 

Azole MOA

Inhibit fungal CYP450 enzymes needed to make ergosterol l/t disruption of fungal cell membrane formation l/t slowed/stopped fungal growth

Disadvantage of Azoles

Inhibits P450 drug-metabolizing enzymes and can increase levels of other drugs

Itraconazole

Broader spectrum than most azoles, well absorbed from GI when given with meals, highly bound to plasma proteins, long half-life

Adverse Effects of Itraconazole

Cardiosuppression, hepatotoxicity, hypokalemia, hypertension

Fluconazole

Well absorbed from GI tract and distributed throughout body + CNS, treatment of cryptococcal meningitis, long half-life, effective in immunocompromised patients 

Fluconazole Adverse Effects

GI disturbances (N/V/pain), headaches, rashes, seizures, anaphylaxis, dermatitis

Ketoconazole

1^st oral antifungal approved for chronic systemic mycoses, well absorbed from GI if stomach content is acidic (antacids + antihistamines decrease absorption), well tolerated

Ketoconazole Adverse Effects

Inhibits synthesis of testosterone + estradiol (gynecomastia, menstrual irregularities, alterations in adrenal steroid synthesis), severe hepatotoxicity

Tolnaftate

Treats superficial mycoses (superficial skin + nail infections), generally ineffective against yeast

Adverse Effects of Tolnaftate

Allergic contact dermatitis, possibly teratogenic

Clotrimazole

Treats superficial mycoses, spectrum and MOA similar to azoles, used for various mucosal and cutaneous infections, restricted for topical use only

Miconazole

1^st azole approved for topical and parenteral use, used for cutaneous and vaginal c. albicans infections

Adverse Effects of Miconazole

May cause burning, redness, itching