2. INTRODUCTION
• Fungal infections may be systemic and superficial
• They may occur as primary disease or secondary to treatment with
antibiotics,anticancer drugs or due to HIV infection
3. CLASSIFICATION OF ANTI FUNGAL
DRUGS
ANTIFUNGAL ANTIBIOTICS
i)POLYENES Amphotericin B
Nystatin
Hamycin
ii)OTHERS Griseofulvin
ANTIMETABOLITES Flucytosine(5 FC)
AZOLES
i)IMIDAZOLE Clotrimazole
Miconazole
Ketaconazole
Econazole
ii)TRIAZOLES Fluconazole
Itraconazole
teraconazole
ALKYLAMINES Terbinafine
OTHER TOPICAL AGENTS Tolnaftate
Benzoic acid
ciclopirox
4. AMPHOTERICIIN B
• It is a polyene antibiotic
• It is obtained from Streptomyces nodosus
• it is fungistatic at low and fungicidal at high concentration
• Amphotericin is not absorbed orally.it is given I.V and it is widely distributed
in the body
Adverse effect
• Fever,chills,muscle spasm,vomiting,hypotension and headache on I.V infusion
• Pain and thrombophlebitis at the site of injection
• Also renal impairment,neurotoxicity and anemia
5. NYSTATIN
• It is obtained from Streptomyces noursei
• It has action similar to amphotericin B
• But it is too toxicfor systemic use
• So it is used topically
• It is used in local cnandidial infections like oral thrush and vaginal candidias
HAMYCIN
• It is another polyene antibiotic
• It is used topically for cutaneous candidias and otomycosis
6. GRISEOFULVIN
• It is a fungistatic
• It is obtained from penicillium griseofulvum
• It is given orally for superficial dermatophytosis
• It acts by binding to micro tubular protein in the nucleus
• This distrupts mitotic spindle and inhibits mitosis in the fungus
• Griseofulvin is poorly water soluble
• Also bioavailability is poor microfined particles or fatty food enhance its
absorption
• It binds to keratin of the skin
Adverse effect
• Allergic reactions,hepatitis and nephrotoxicity
7. ANTIMETABOLITES
FLUCYTOSINE
• It is a fluorinated pyrimidine
• It is effective agaist Cryptococcus neoformans and candida
• It is converted to 5-fluorouracil which inhibits DNA synthesis
Adverse effects
• Bone marrow depression and GI disturbances
Uses
• It is used in cryptococcal meningitis and systemic candidias
8. AZOLES
IMIDAZOLES & TRIAZOLES
• Azoles are newer synthetic antifungals
• They are orally effective and less toxic
• They have broad spectrum antifungal activity
KETOCONAZOLE
• It is orally effective and is well absorbed
• Food and low gastric pH enchance its absorption
9. Adverse effect
• Gastric irritation,nausea,vomiting,headache and allergic reactions
• Inhibition of adrenal and gonadal steroid synthesis
• This results in gynecomastia,infertility,loss of libido and azoospermia
Uses
• Mucocutaneous candidiasis and dermatophytosis
• Cushing syndrome
• Deep mycosis
10. ITRACONAZOLE
• It is the most potent azole
• It is given orally
• Absorption is increased by food and gastric acid
• Less effect on hepatic microsomal enzymes
• Also it does not affect steroid synthesis
• It is available both for oral and I.V use
11. TERBINAFINE
• It is a synthetic anti fungal effective against dermatophytes and candida
• It is fungicidal and orally effective
• It gets concentrated in keratin it acts by inhibiting ergosrerol synthesis
Adverse effect
• GI disturbances,rashes and headache
