Chapter 126 : Antifungal Agents

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This chapter reviews the four major families of antifungal drugs that are available for systemic administration: the allylamines, the azoles, the echinocandins, and the polyenes. It discusses the characteristics of other agents that can be used for the oral or parenteral treatment of superficial, subcutaneous, or systemic fungal infections. The allylamines are a group of synthetic antifungal compounds effective in the topical and oral treatment of dermatophytoses. The azoles constitute a large group of synthetic agents containing many compounds that are effective in the topical treatment of dermatophyte infections and superficial forms of candidiasis. The activity is essentially fungistatic, although some of the newer triazoles can exert fungicidal effects against some mold species at the concentrations achieved with recommended dosages. Three echinocandins have been approved for the treatment of serious fungal infections: anidulafungin, caspofungin, and micafungin. Acquired resistance to echinocandins is rare at present, but resistant strains of several spp. have been recovered from patients failing caspofungin treatment. The echinocandins do not interact with the human hepatic cytochrome P-450 system, and their use has been associated with very few significant drug interactions. The polyenes bind to sterols, principally ergosterol, in the membranes of susceptible fungal cells causing impairment of membrane barrier function, leakage of cell constituents, metabolic disruption, and cell death. As more compounds have become licensed, the number of novel antifungal drugs entering preclinical development appears to have diminished.

Citation: Warnock D. 2011. Antifungal Agents , p 1995-2007. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch126
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Generic image for table

Spectrums and extents of activity of commonly used systemic antifungal agents

This table is a general overview for comparison of the activities of some systemic drugs against various fungi. Readers are recommended to refer to the text for more detailed information.

–, no meaningful activity; +, occasional activity; ++, moderate activity but resistance is noted; +++, reliable activity with occasional resistance.

Citation: Warnock D. 2011. Antifungal Agents , p 1995-2007. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch126

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