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Antifungal drugs Pharmacology, Classifications, Examples, Mechanism of action and Side effects
Antifungals are drugs used in the treatment of fungal infections. In this video we cover the classification, pharmacology, indications and side effects of these antifungal agents.
I. Antifungals damaging permeability of the cell membrane
Imidazoles: Clotrimazole, Econazole, Ketoconazole, Miconazole
Triazoles: Fluconazole, Itraconazole, Voriconazole
Allylamines: Terbinafine, Naftifine
Morpholines: Amorolfine
Thiocarbamates: Tolciclate, Tolnaftate
Substituted pyridones: Ciclopirox
Polyene antibiotics: Amphotericin B, Nystatin
II. Antifungals inhibiting chitin synthesis in the cell wall
Caspofungin, Griseofulvin
III. Antifungals inhibiting synthesis of nucleic acids
Flucytosine
Polyene antifungals
Amphotericin B and Nystatin work by binding to the fungal cell membrane component ergosterol, leading to increased fungal cell membrane permeability and the loss of intracellular constituents.
Amphotericin has a lesser affinity for the mammalian cell membrane component cholesterol, but this interaction does account for most adverse toxic effects.
Amphotericin B has activity against Candida spp., Cryptococcus neoformans, Blastomyces dermatitidis, Histoplasma capsulatum, Sporothrix schenckii, Coccidioides immitis, Paracoccidioides braziliensis, Aspergillus spp., Penicillium marneffei, etc.
Amphotericin is used intravenously for treatment of Candida esophagitis, rapidly progressive mucormycosis or invasive aspergillosis.
Intrathecal infusion of amphotericin B is useful in patients with meningitis caused by Coccidioides.
Intravenous administration of amphotericin B is the treatment of choice for mucormycosis and is used for the initial treatment of cryptococcal meningitis, severe or rapidly progressing histoplasmosis, blastomycosis, and coccidioidomycosis.
Intraocular injection is used successfully for fungal endophthalmitis.
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