Table 1

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Options for Treatment of Superficial Fungal Infections*
Drugs Formulations Uses
Allylamines
Amorolfine 5% solution Tinea unguium
Naftifine



1% cream or gel Dermatophytoses, skin
candidiasis
Terbinafine




Topical: 1% cream or solution Dermatophytoses
Oral: 250-mg tablet
Benzylamine
Butenafine




1% cream Dermatophytoses
Imidazoles
Butoconazole



2% cream Vulvovaginal candidiasis
Clotrimazole





Topical: 1% cream, lotion, or
solution; 100-, 200-, and 500-
mg vaginal suppository tablets
Dermatophytoses,
candidiasis
(oropharyngeal, skin,
vulvovaginal)
Oral: 10-mg lozenges
Econazole


1% cream Dermatophytoses, skin
candidiasis, tinea
versicolor
Fluconazole



50 and 200 mg/5 mL solution;
50-, 100-, 150-, and 200-mg
tablets
Candidiasis
(vulvovaginal, skin,
oropharyngeal)
Itraconazole



100-mg capsules, 10 mg/mL
solution
Tinea unguium, other
onychomycoses
Ketoconazole



2% cream, 1 to 2% shampoo,
200-mg tablet
Dermatophytoses, skin
candidiasis
Miconazole




1 to 2% liquid (aerosol), 2%
powder (aerosol), 1 to 2%
cream and lotion, 1% solution,
2% powder or tincture, 100- or
200-mg vaginal suppositories
Dermatophytoses,
candidiasis (skin,
vulvovaginal)
Oxiconazole



1% cream or lotion Dermatophytoses, tinea
versicolor
Sulconazole



1% cream or solution Dermatophytoses, tinea
versicolor
Terconazole





0.4% and 0.8% cream, 80-mg
suppositories
Vulvovaginal candidiasis
Tioconazole

6.5% ointment Vulvovaginal candidiasis



Polyene
Nystatin




Topical: 100,000 U/g cream,
ointment, powder, or vaginal
tablet
Candidiasis
(oropharyngeal, skin)
Oral: 100,000 U/mL
suspension, 500,000-U tablets

Miscellaneous
Carbolfuchsin Solution Chronic
dermatophytoses,
intertrigo
Ciclopirox




0.77% gel, 8% lacquer solution Dermatophytoses,
candidiasis, tinea
versicolor,
onychomycosis
Clioquinol 3% cream Dermatophytoses
Gentian violet 1 or 2% solution Dermatophytoses,
especially tinea pedis;
sometimes candidiasis
Griseofulvin





125-, 165-, 250-, 330-, and 500-
mg tablets
Dermatophytoses
Tolnaftate



1% liquid, powder, liquid or
aerosol spray, cream, or
solution
Dermatophytoses, tinea
versicolor
Zinc
Undecylenate/undecylenate
acid
25% solution, 10% tincture Superficial
dermatophyte
infections (eg, tinea
pedis)
*Advantages of one topical drug over another for most infections are not clear. For skin infections,
allylamines have good activity against dermatophytes but weaker activity against Candida;imidazoles
have better activity against both dermatophytes and Candida. Adverse effects are rare, but all topical
antifungals can cause skin irritation, burning, and contact dermatitis. Drug doses may vary by indication.
Oral antifungals can cause hepatitis and neutropenia. Periodic laboratory monitoring of hepatic function
and of CBC is recommended when oral antifungals (eg, itraconazole


, terbinafine



) are given for > 1 mo.
Drug interactions may occur. For example, itraconazole


may interact with lovastatin



,midazolam


, simvastatin


, and triazolam


. Cisapride


, dofetilide


, pimozide


, orquinidine



should not be used with itraconazole


; taking these drugs with itraconazole


may cause cardiac arrhythmias.







Antifungal medicines have many brand names as they are
made by different pharmaceutical manufacturers.
There are also many different types of antifungal medicines,
including:
clotrimazole
econazole nitrate
miconazole
terbinafine
fluconazole
ketoconazole
amphotericin
The packaging should state what antifungal medicine the product
contains and how much. This may be shown as a percentage
for example, cream containing 1% clotrimazole, or in milligrams
(mg) for example, capsules containing 50mg of fluconazole.
Types of antifungal medicines
Antifungal medicines are available as:
topical antifungals a cream, gel, ointment or spray applied directly to the body
oral antifungals a capsule, tablet or liquid medicine that is swallowed
intravenous antifungals an injection into a vein in your arm, usually in hospital
through an intravenous infusion (a continuous drip of medicine through a narrow
tube)
Antifungal intravaginal pessaries are also available. Pessaries
are small suppositories inserted into the vagina to treat conditions
such as vaginal thrush.









Things to consider when using
antifungal medicines
Before you take antifungals there are a number of things you should discuss with your GP.
Allergies
You are generally advised not to take an antifungal medicine if you are allergic to the medicine or any
of the ingredients used in it.
In some cases, such as when treating invasive fungal infections in hospital, your doctors may feel the
benefit of the medicine outweighs the risk of an allergic reaction. They may decide to use the
medicine and monitor you closely.
Other conditions
Be careful with some oral antifungals if you have problems with your heart, liver or kidneys.
Discuss your condition with your GP or pharmacist to find out which antifungal medicines are safe for
you to use.
Topical antifungals
If you are using a topical antifungal medicine, such as a cream, avoid it coming into contact with:
your eyes
moist linings (mucous membranes), for example, inside your nose or mouth (unless it
is a gel that is supposed to be used in your mouth)
Contraceptives
Some antifungal medicines are designed to be used on a man's penis or in or around a woman's
vagina. Antifungal creams or vaginal suppositories (pessaries) are sometimes used to treat thrush.
However, these types of antifungal medicines can damage latex condoms and diaphragms, making
them less effective. Use a different method of contraception while you are using the antifungal
medicine, or avoid having sex.
Some types of antifungal medicines can also interact with oestrogens and progestogens, which are
found in some types of hormonal contraceptives, such as the combined contraceptive pill. You may
experience some breakthrough bleeding while taking your antifungal medicine, but your contraceptive
protection should not be affected.
Only oral antifungal medicines interact with oestrogens.
Pregnancy
Many antifungal medicines are not suitable to take during pregnancy. Check the patient information
leaflet that comes with your medicine to find out.
However, if you have vaginal thrush during pregnancy, your GP may prescribe an antifungal
suppository that can be inserted into your vagina (a pessary) or an antifungal cream.
Breastfeeding
Small amounts of some medicines can pass into your breast milk and may then be passed on to your
baby if you are breastfeeding. Check the patient information leaflet that comes with your antifungal
medicine, as many medicines should not be taken while breastfeeding.





Antifungal medicines are used to treat fungal infections.
Fungal infections
Fungi are plant-like organisms that feed by breaking down living
tissue.
Fungi that cause infections in humans are known as
dermatophytes. Dermatophytes are particularly attracted to a type
of tissue called keratin, which is a tough, waterproof tissue found
in many parts of the body such as in the:
nails
hair
skins outer surface
This explains why fungal infections often occur on the skin, nails
and scalp.
Common fungal infections
Antifungal medicines may be used to treat the following common
fungal infections:
ringworm which causes a ring-like red rash on the skin of the body or scalp
athletes foot which affects the skin on the feet, causing it to become red, flaky and
itchy
fungal nail infection which causes the toenails or fingernails to become thickened
and discoloured, and sometimes brittle, with pieces of nail breaking off
vaginal thrush which causes irritation and swelling of the vagina and vulva (the
female external sexual organs)
Invasive fungal infections
Invasive fungal infections are a less common, but more serious,
type of fungal infection. They are infections that occur deep inside
the bodys tissue or in one of the organs, such as in the:
brain for example, fungal meningitis, where a fungus causes an infection of the
protective membranes that surround the brain and spinal cord
lungs for example, aspergillosis, which is a lung infection caused by a fungal mould
called aspergillus
People with a weakened immune system (the bodys natural
defence system) are particularly vulnerable to invasive fungal
infections. Those at risk include:
people with HIV and AIDS
people having high-dose chemotherapy to treat cancer
people who are taking immunosuppresants medicines to suppress the immune
system (the bodys natural defence against infection and illness), often used after an
organ transplant
How antifungal medicines work
Antifungal medicines work by either:
killing the fungal cells for example, by affecting a substance in the cell wall, causing
the contents of the cell to leak out and the cell to die
preventing the fungal cells from growing and reproducing
Types of antifungal medicines
Antifungal medicines are used in several ways, depending on
your specific fungal infection. The main types of antifungal
medicines include:
topical antifungals, applied to the skin, hair or nails
oral antifungals, swallowed in capsule, pill or liquid form
intravenous antifungals, injected into your bloodstream
Read more about the types of antifungal medicines.
Things to consider
Before taking antifungal medicines, there are various things to
consider, such as any existing conditions or allergies that may
affect your treatment for fungal infection.
Read more about special considerations for antifungal medicines.
Side effects
As with all medicines, antifungal medicines have side effects.
These depend on the type of medication you're taking. In most
cases, the side effects are mild and only last a short time, but
there are rare cases of more serious problems.
Common side effects include:
irritation of the skin
diarrhoea
feeling sick
indigestion
In rare cases, liver damage can occur as a result of using
antifungal medicines.
Read more about the side effects of antifungal medicines.
Interactions with other medicines
When two or more medicines are taken at the same time, they
can sometimes affect how each other works, this is known as
interaction.
There are several medicines that can interact with antifungal
medicines.
Read more about medicines that can interact with antifungal
medicines.
Dosage
Your GP or pharmacist should advise on how to take or use your
antifungal medicine. For further information, see the patient
information leaflet that comes with your medicine or the
Medicines information tab above.
Speak to your GP or pharmacist if you take too much of your
antifungal medicine. You may be advised to visit your nearest
hospitals accident and emergency (A&E) department. If you are
advised to go to hospital, take the medications packaging with
you so that the healthcare professionals who treat you know what
you have taken.