This document summarizes several common antifungal drugs including polyenes like amphotericin B and nystatin, azoles like ketoconazole and itraconazole, and other drugs like griseofulvin and flucytosine. Amphotericin B is a polyene antibiotic obtained from Streptomyces nodosus that is fungistatic at low doses and fungicidal at high doses but must be given intravenously. Ketoconazole is an oral imidazole azole antifungal that is well absorbed but can cause side effects like gastric irritation and inhibition of steroid synthesis. Itraconazole is a potent triazole azole with

1. ANTI-FUNGAL DRUGS
Presented by:
Dr: Ahmed mandour.&Dr: Ahmed Samir.

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. ANTIFUNGAL ANTIBIOTICS
i)POLYENES Amphotericin B
Nystatin
Hamycin
ii)OTHERS Griseofulvin
ANTIMETABOLITES Flucytosine(5 FC)
AZOLES
CLASSIFICATION OF ANTI FUNGAL
DRUGS i)IMIDAZOLE Clotrimazole
Miconazole
Ketaconazole
Econazole
ii)TRIAZOLES Fluconazole
Itraconazole
teraconazole
ALKYLAMINES Terbinafine
OTHER TOPICAL AGENTS Tolnaftate
Benzoic acid
ciclopirox

4. AMPHOTERICIIN B (Ambisome 50 mg vial)
•
•
•
•
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 (Nystatin)
•
•
•
•
•
It is obtained from Streptomyces noursei
It has action similar to amphotericin B
But it is too toxic for systemic use
So it is used topically
It is used in local cnandidial infections like oral thrush and vaginal candidias
HAMYCIN (Hamycin lotion)
•
•
It is another polyene antibiotic
It is used topically for cutaneous candidias and otomycosis

6. GRISEOFULVIN (Fulvin tab)
•
•
•
•
•
•
•
•
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 (Cytoflu )
•
•
•
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 (Fungizol 200 mg tab)
•
•
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 (Itracon 100 mg cap)
•
•
•
•
•
•
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 (Terbin 250 mg tab)
•
•
•
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

12. THANK YOU