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ANTI-FUNGAL
AGENTS
BY
KENCHA SWATHI
ASSISTANT PROFESSOR
BANGALORE
Swathi Pharma Jnan
FUNGAL INFECTIONS
■ Fungal infections are also called as Mycoses
■ Mycoses are of 2 well defined groups
1. Systemic mycoses
2.Superficial mycoses
Swathi Pharma Jnan
SYSTEMIC MYCOSES
■ Sporadic distribution is very common in some areas and not common in
other areas.
■ Soil inhabiting saprophytes causes systemic mycoses
■ They can adapt to the internal environment of the host by lungs,which
is a common route.
■ The infection can be found by skins test or immunological procedures.
■ Body produces gaint cells/walling off
■ Lesions are detected by autopsy/X-ray.
Eg: Histoplasmosis,sporotrichosis,Blastomycosis,Coccidiodomycosis,
Cryptococcosis,Paracoccidiodomycoses
Swathi Pharma Jnan
OPPURTUNISTIC FUNGAL INFECTIONS
■ These are the new type of systemic infections which occurs due to
overuse of immunosuppressive agents, antibiotics, steroids,
cytotoxins,Infra red radiations.
Eg: Systemic candidiasis,Aspergillosis
Swathi Pharma Jnan
SUPERFICIAL MYCOSES
Superficial mycoses is of 2 types.
1.Cutaneous superficial mycoses
2.Subcutaneous superficial mycoses
 Cutaneous infections are most common compared to subcutaneous
infection.
 Cutaneous infection occurs in keratinized epidermis and epidermal
appendages like hair ,nail etc..,
Eg:Trichophyton infection,Microsporum infection,Tinea infections
(Hand,groin,beard,scalp,nails)
 Subcutaneous infection involves skin as well as subcutaneous tissue.
Eg: Chromomycoses,sporotrichosis,Mycetoma,Lobomycoses
Swathi Pharma Jnan
FUNGAL INFECTIONS-REACTIONS
■ Tissue actions of fungal diseases shows different response
and it varies widely depends on type of organism involved.
■ That reactions include severe inflammation followed by scar
formation,Keloid formation(projections).
■ A uniform acute pyogenic(formation of pus) takes
place,granuloma with ceseations & fibro caseous ,pulmonary
granuloma.
Swathi Pharma Jnan
ANTIFUNGALAGENTS
■ Drugs used in the treatment of various types of fungal
infections(mycoses) are called as antifungal agents.
Swathi Pharma Jnan
CHEMICAL CLASSIFICATION
Antifungal agents are classified based on their chemical structure:
1.Azoles- Clotrimazole,Miconazole,Ketoconazole
2.Allyl amines and related compounds- Naftifine,Tolnaftate
3.Fatty acids and its derivatives-Zinc propionate,Sodium caprylate
4.Phenols and its derivatives- Haloprogin,Cyclopirox olamine
5.Nucleosides- Flucytosine
6.Anti-fungal antibiotics-Natamycin,Amphoterecin-B,Nystatin,Candicidin
7.Other antifungal antibiotics- Griseofulvin
8.Miscellaneous antifungal agents- Acrisorcin
Swathi Pharma Jnan
CLOTRIMAZOLE
Uses: Topically it is used in the treatment of tinea pedes,T.cruris,
T.capitis & cutaneous candidiasis.
It is also used for vulvo vaginal candidiasis.
Swathi Pharma Jnan
MICONAZOLE
Uses:To treat candidiasis,coccidiodomycoses,Paracoccidiodomycoses.
It is also used to treat chronic mucocutaneous candidiasis.
To treat tinea infections.
Swathi Pharma Jnan
KETOCONAZOLE
Uses: Ketoconazole is a broad spectrum imidazole antifungal agent
Used to treat systemic fungal infections like
candidiasis,Coccidiodomycoses,Histoplasmosis,Blastomycoses,Chromomycose
s.
To treat cutaneous dermatophytic infections.
Swathi Pharma Jnan
Acetyl Piperazine Phenyl
Dichlorophenyl
Imidazole
Dioxalan
NAFTIFINE
Uses: In topical treatment of ringworm,Athlets foot,Jock itch
Swathi Pharma Jnan
Napthalene
TOLNAFTATE
Uses: In topical treatment of ringworm,Athlets foot and jock itch
Swathi Pharma Jnan
ZINC PROPIONATE
Uses: Fungicide
Particularly used on adhesive tapes
Swathi Pharma Jnan
SODIUM CAPRYLATE
Uses: It is used topically to treat superficial dermatomycoses caused by
Candida albicans,Trycophytan ,Mycosporum,Epidermophyton species.
Swathi Pharma Jnan
HALOPROGIN
Uses:Treatment of tinea infections
Swathi Pharma Jnan
CYCLOPIROX
Uses: Broad spectrum antifungal agent for topical use.
In the treatment of cutaneous candidiasis,tinea corporis,Tinea cruris
infections.
It is a second line agent for the treatment of
onyochomycoses(Ringworm of nails)
Swathi Pharma Jnan
FLUCYTOSINE
Uses: Narrow spectrum antifungal agent
To treat serious systemic infections caused by susceptible strains of
candida and cryptococcus species.
Swathi Pharma Jnan
NATAMYCIN
Uses: In the treatment of fungal conjunctivitis
To treat Blepharitis(Inflammation of eyelids)
To treat Keratitis(Inflammation of cornea)
Swathi Pharma Jnan
AMPHOTERECIN-B
Uses: Parentral amphotericin-B is used for the treatment of severe
potentially life threatening fungal infections including coccidiodomycoses,
Histoplasmoses,North American Blastomycoses & Aspergillosis.
Topically it is used to treat cutaneous and mucocutaneous mycoses
caused by candida albicans.
Swathi Pharma Jnan
NYSTATIN
Uses: For the treatment of local and GIT Candida infections caused by
candida albicans and other candida species.
To control vaginal candidiasis.
Swathi Pharma Jnan
CANDICIDIN
Uses:Topically it is an antifungal agent to treat cutaneous and
mucocutaneous mycoses.
Swathi Pharma Jnan
GRISEOFULVIN
Uses: For the treatment of ringworm and fungal infections on the hair, nails & feet caused
by various species of fungi.
Swathi Pharma Jnan
ACRISORCIN
(9-Amino acridine compound with 4-hexyl resorcinol)
Uses:To treat fungal infections.
Swathi Pharma Jnan
MOA OF AZOLES
■ Azoles are fungicidal at high concentrations.
■ They are fungistatic at low concentrations.
■ Fungicidal effect is due to the damage of cell-membrane with the loss of essential
cellular components such as K+ and amino acids.
■ Fungistatic effect is due to the inhibition of membrane bound enzymes such as
cytP-450 involved in the fungal sterol biosynthesis particularly lanosterol 14α-
demethylase.
■ This enzyme is essential for the biosynthesis of ergosterol,the principle sterol
component of fungal cell membrane.
■ Lanosterol 14α-demethylase is also required for the biosynthesis of
Cholesterol.
Swathi Pharma Jnan
Squalene Squalene epoxide
Swathi Pharma Jnan
Lanosterol
14 demethyl
lanosterol
Ergosterol
Squalene
epoxide cyclase
Lanosterol 14α-
demethylase
Squalene
epoxidase
(Azoles)
Inhibits
(Allyl amines)
Inhibits
MOA OF ALLYLAMINES
■ Tolnaftate,Naftifine drugs interfere with early step of
ergosterol biosynthesis namely epoxidation of squalene by
Squalene epoxidase.
Swathi Pharma Jnan
MOA OF FATTY ACIDS & PHENOLS
■ Seabum ,an acid in and on the skin is a natural antifungal
agent.Fatty acid like seabum when applied to the infected
area acts as antifungal agents.Salts of fatty acids are also
fungicidal.
Eg: Zinc propionate,Sodium caprylate
■ They interfere with cell-membrane integrity and function in
susceptible fungi.
Eg: Haloprogin,Cyclopirox
Swathi Pharma Jnan
MOA OF NUCLEOSIDES
■ 5-Fluoro cytosine undergoes deamination to form 5-Fluro uracil.
■ 5-Fluoro uracil converts to 5-Fluoro uridine monophosphate,then diphosphate,triphosphate
and enters into RNA (by formation of faulty RNA) or blocks the synthesis of DNA causes cell-
death.
5-Fluoro cytosine 5-Fluoro cytosine 5-Fluoro uracil
5-Fluoro uridine diphosphate 5-Fluoro uridine monophosphate
5-Fluoro uridine triphosphate RNA(Faulty) Cell-death
Swathi Pharma Jnan
Active
transport
(Out of cell) (Inside of cell)
MOA OF ANTIFUNGALANTIBIOTICS
■ These drugs penetrate the fungal cell-membrane becoz of their three
dimensional shape.
■ After penetrating into the cell membrane they act as false membrane
components and binds with ergosterol causing membrane disruption
and loss of cellular constituents especially potassium ions.
Swathi Pharma Jnan
MOA OF GRISEOFULVIN
■ Griseofulvin is a mitotic spindle poison.
■ It arrests the cell-division in metaphase.
■ It binds with tubulin dimer which is required for microtubule formation.
■ Then shows selective toxicity to fungi and causes cell-death
Swathi Pharma Jnan
LIKE,SHARE AND SUBSCRIBE
Swathi Pharma Jnan

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Anti fungal agents

  • 2. FUNGAL INFECTIONS ■ Fungal infections are also called as Mycoses ■ Mycoses are of 2 well defined groups 1. Systemic mycoses 2.Superficial mycoses Swathi Pharma Jnan
  • 3. SYSTEMIC MYCOSES ■ Sporadic distribution is very common in some areas and not common in other areas. ■ Soil inhabiting saprophytes causes systemic mycoses ■ They can adapt to the internal environment of the host by lungs,which is a common route. ■ The infection can be found by skins test or immunological procedures. ■ Body produces gaint cells/walling off ■ Lesions are detected by autopsy/X-ray. Eg: Histoplasmosis,sporotrichosis,Blastomycosis,Coccidiodomycosis, Cryptococcosis,Paracoccidiodomycoses Swathi Pharma Jnan
  • 4. OPPURTUNISTIC FUNGAL INFECTIONS ■ These are the new type of systemic infections which occurs due to overuse of immunosuppressive agents, antibiotics, steroids, cytotoxins,Infra red radiations. Eg: Systemic candidiasis,Aspergillosis Swathi Pharma Jnan
  • 5. SUPERFICIAL MYCOSES Superficial mycoses is of 2 types. 1.Cutaneous superficial mycoses 2.Subcutaneous superficial mycoses  Cutaneous infections are most common compared to subcutaneous infection.  Cutaneous infection occurs in keratinized epidermis and epidermal appendages like hair ,nail etc.., Eg:Trichophyton infection,Microsporum infection,Tinea infections (Hand,groin,beard,scalp,nails)  Subcutaneous infection involves skin as well as subcutaneous tissue. Eg: Chromomycoses,sporotrichosis,Mycetoma,Lobomycoses Swathi Pharma Jnan
  • 6. FUNGAL INFECTIONS-REACTIONS ■ Tissue actions of fungal diseases shows different response and it varies widely depends on type of organism involved. ■ That reactions include severe inflammation followed by scar formation,Keloid formation(projections). ■ A uniform acute pyogenic(formation of pus) takes place,granuloma with ceseations & fibro caseous ,pulmonary granuloma. Swathi Pharma Jnan
  • 7. ANTIFUNGALAGENTS ■ Drugs used in the treatment of various types of fungal infections(mycoses) are called as antifungal agents. Swathi Pharma Jnan
  • 8. CHEMICAL CLASSIFICATION Antifungal agents are classified based on their chemical structure: 1.Azoles- Clotrimazole,Miconazole,Ketoconazole 2.Allyl amines and related compounds- Naftifine,Tolnaftate 3.Fatty acids and its derivatives-Zinc propionate,Sodium caprylate 4.Phenols and its derivatives- Haloprogin,Cyclopirox olamine 5.Nucleosides- Flucytosine 6.Anti-fungal antibiotics-Natamycin,Amphoterecin-B,Nystatin,Candicidin 7.Other antifungal antibiotics- Griseofulvin 8.Miscellaneous antifungal agents- Acrisorcin Swathi Pharma Jnan
  • 9. CLOTRIMAZOLE Uses: Topically it is used in the treatment of tinea pedes,T.cruris, T.capitis & cutaneous candidiasis. It is also used for vulvo vaginal candidiasis. Swathi Pharma Jnan
  • 10. MICONAZOLE Uses:To treat candidiasis,coccidiodomycoses,Paracoccidiodomycoses. It is also used to treat chronic mucocutaneous candidiasis. To treat tinea infections. Swathi Pharma Jnan
  • 11. KETOCONAZOLE Uses: Ketoconazole is a broad spectrum imidazole antifungal agent Used to treat systemic fungal infections like candidiasis,Coccidiodomycoses,Histoplasmosis,Blastomycoses,Chromomycose s. To treat cutaneous dermatophytic infections. Swathi Pharma Jnan Acetyl Piperazine Phenyl Dichlorophenyl Imidazole Dioxalan
  • 12. NAFTIFINE Uses: In topical treatment of ringworm,Athlets foot,Jock itch Swathi Pharma Jnan Napthalene
  • 13. TOLNAFTATE Uses: In topical treatment of ringworm,Athlets foot and jock itch Swathi Pharma Jnan
  • 14. ZINC PROPIONATE Uses: Fungicide Particularly used on adhesive tapes Swathi Pharma Jnan
  • 15. SODIUM CAPRYLATE Uses: It is used topically to treat superficial dermatomycoses caused by Candida albicans,Trycophytan ,Mycosporum,Epidermophyton species. Swathi Pharma Jnan
  • 16. HALOPROGIN Uses:Treatment of tinea infections Swathi Pharma Jnan
  • 17. CYCLOPIROX Uses: Broad spectrum antifungal agent for topical use. In the treatment of cutaneous candidiasis,tinea corporis,Tinea cruris infections. It is a second line agent for the treatment of onyochomycoses(Ringworm of nails) Swathi Pharma Jnan
  • 18. FLUCYTOSINE Uses: Narrow spectrum antifungal agent To treat serious systemic infections caused by susceptible strains of candida and cryptococcus species. Swathi Pharma Jnan
  • 19. NATAMYCIN Uses: In the treatment of fungal conjunctivitis To treat Blepharitis(Inflammation of eyelids) To treat Keratitis(Inflammation of cornea) Swathi Pharma Jnan
  • 20. AMPHOTERECIN-B Uses: Parentral amphotericin-B is used for the treatment of severe potentially life threatening fungal infections including coccidiodomycoses, Histoplasmoses,North American Blastomycoses & Aspergillosis. Topically it is used to treat cutaneous and mucocutaneous mycoses caused by candida albicans. Swathi Pharma Jnan
  • 21. NYSTATIN Uses: For the treatment of local and GIT Candida infections caused by candida albicans and other candida species. To control vaginal candidiasis. Swathi Pharma Jnan
  • 22. CANDICIDIN Uses:Topically it is an antifungal agent to treat cutaneous and mucocutaneous mycoses. Swathi Pharma Jnan
  • 23. GRISEOFULVIN Uses: For the treatment of ringworm and fungal infections on the hair, nails & feet caused by various species of fungi. Swathi Pharma Jnan
  • 24. ACRISORCIN (9-Amino acridine compound with 4-hexyl resorcinol) Uses:To treat fungal infections. Swathi Pharma Jnan
  • 25. MOA OF AZOLES ■ Azoles are fungicidal at high concentrations. ■ They are fungistatic at low concentrations. ■ Fungicidal effect is due to the damage of cell-membrane with the loss of essential cellular components such as K+ and amino acids. ■ Fungistatic effect is due to the inhibition of membrane bound enzymes such as cytP-450 involved in the fungal sterol biosynthesis particularly lanosterol 14α- demethylase. ■ This enzyme is essential for the biosynthesis of ergosterol,the principle sterol component of fungal cell membrane. ■ Lanosterol 14α-demethylase is also required for the biosynthesis of Cholesterol. Swathi Pharma Jnan
  • 26. Squalene Squalene epoxide Swathi Pharma Jnan Lanosterol 14 demethyl lanosterol Ergosterol Squalene epoxide cyclase Lanosterol 14α- demethylase Squalene epoxidase (Azoles) Inhibits (Allyl amines) Inhibits
  • 27. MOA OF ALLYLAMINES ■ Tolnaftate,Naftifine drugs interfere with early step of ergosterol biosynthesis namely epoxidation of squalene by Squalene epoxidase. Swathi Pharma Jnan
  • 28. MOA OF FATTY ACIDS & PHENOLS ■ Seabum ,an acid in and on the skin is a natural antifungal agent.Fatty acid like seabum when applied to the infected area acts as antifungal agents.Salts of fatty acids are also fungicidal. Eg: Zinc propionate,Sodium caprylate ■ They interfere with cell-membrane integrity and function in susceptible fungi. Eg: Haloprogin,Cyclopirox Swathi Pharma Jnan
  • 29. MOA OF NUCLEOSIDES ■ 5-Fluoro cytosine undergoes deamination to form 5-Fluro uracil. ■ 5-Fluoro uracil converts to 5-Fluoro uridine monophosphate,then diphosphate,triphosphate and enters into RNA (by formation of faulty RNA) or blocks the synthesis of DNA causes cell- death. 5-Fluoro cytosine 5-Fluoro cytosine 5-Fluoro uracil 5-Fluoro uridine diphosphate 5-Fluoro uridine monophosphate 5-Fluoro uridine triphosphate RNA(Faulty) Cell-death Swathi Pharma Jnan Active transport (Out of cell) (Inside of cell)
  • 30. MOA OF ANTIFUNGALANTIBIOTICS ■ These drugs penetrate the fungal cell-membrane becoz of their three dimensional shape. ■ After penetrating into the cell membrane they act as false membrane components and binds with ergosterol causing membrane disruption and loss of cellular constituents especially potassium ions. Swathi Pharma Jnan
  • 31. MOA OF GRISEOFULVIN ■ Griseofulvin is a mitotic spindle poison. ■ It arrests the cell-division in metaphase. ■ It binds with tubulin dimer which is required for microtubule formation. ■ Then shows selective toxicity to fungi and causes cell-death Swathi Pharma Jnan