Antifungal Therapeutics

Antifungal drugs are used to treat infections caused by fungus and to prevent the development of fungal infections in patients with weakened immune systems.

There are three classes of drugs typically used to treat fungal infections: polyenes, azoles, and echinocandins.

Polyenes

polyenes’ are drugs that work by attaching to the sterol component found in the fungal membrane, causing the cells to become porous and die. The two polyenes most commonly used are nystatin (Mycostatin) and amphotericin B (Fungizone). Nystatin is often used as a topical agent to treat superficial infections, or is taken orally to treat candidal infections such as oral or esophageal candidiasis.

Amphotericin B was the first antifungal drug to be approved for use, and it is still the standard therapy for the most severe systemic fungal infections. Recently, several new types of amphotericin B (Abelcet, Amphotec and AmBisome) have been introduced. These drugs, called lipid formulations, cause fewer side effects than traditional amphotericin B but are more expensive.

Azoles

Azoles stop fungal growth by preventing fungi from making an essential part of their cell wall. Three typical azoles are ketoconazole (Nizoral), fluconazole (Diflucan), and itraconazole (Sporanox). Ketoconazole is the oldest of these three drugs, and has been used since the 1970s. It is slightly more toxic than the other azoles and does not work for aspergillosis and many candidiasis infections.

Although fluconazole is effective against both superficial and systemic candidiasis, some strains of this fungus have now become resistant to the drug. Itraconazole, the newest of the azoles, is effective against a range of different fungal infections. Unlike ketoconazole or fluconazole, it can be used to treat aspergillosis.

Echinocandins

Echinocandins are a new class of antifungal drugs that work by disrupting the wall that surrounds fungal cells. Caspofungin (Cancidas) is the first of this new class of drugs to be approved. It is an effective treatment for severe, systemic fungal infections, and is given to patients who do not respond to other therapies.

  • Mycostatin
  • Esophageal candidiasis
  • Caspofungin

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