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Antifungals

Drugs & Medication

Antifungals

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An antifungal drug is medication used to treat fungal infections such as athlete's foot, ringworm and candidiasis (thrush), as well as serious systemic infections like cryptococcal meningitis. Such drugs can be either prescription drugs or OTC drugs.

Contents

List of antifungal drugs

Antifungals work by exploiting differences between mammalian and fungal cells to kill off the fungal organism without significantly harming the host. Unlike bacteria, both fungi and humans are eukaryotes. The basic structure of fungal cells and human cells is nearly identical. This means it is more difficult to find a target for an antifungal medication to attack that does not also exist in the infected organism. Consequently, there are often side-effects to these drugs. Some of these side-effects can be life-threatening.

There are several classes of antifungal drugs.

Polyene antibiotic

The polyene antibiotics bind with sterols in the fungal cell wall, principally ergosterol. This causes the cell's contents to leak out and the cell dies. Animal cells contain cholesterol instead of ergosterol and so they are much less susceptible.

  • Nystatin
    Amphotericin B
    Natamycin
    Rimocidin
    Filipin
    Pimaricin

Imidazole and triazole

The imidazole and triazole groups of antifungal drugs inhibit the enzyme cytochrome P450 14α-demethylase. This enzyme converts lanosterol to ergosterol, and is required in fungal cell wall synthesis. These drugs also block steroid synthesis in humans.

Imidazoles:

  • Miconazole
    Ketoconazole
    Clotrimazole
    Econazole
    Mebendazole
    Bifonazole
    Butoconazole
    Fenticonazole
    Isoconazole
    Oxiconazole
    Sertaconazole
    Sulconazole
    Thiabendazole
    Tioconazole

The triazoles are newer, and are less toxic and more effective:

  • Fluconazole
    Itraconazole
    Ravuconazole
    Posaconazole
    Voriconazole

Allylamines

Allylamines inhibit the enzyme squalene epoxidase, another enzyme required for ergosterol synthesis:

  • Terbinafine - marketed as Lamisil in North America and the UK
    Amorolfine
    Naftifine
    Butenafine

Echinocandin

Echinocandins inhibit the synthesis of glucan in the cell wall, probably via the enzyme 1,3-β glucan synthase:

  • Anidulafungin
    Caspofungin
    Micafungin

Others

Others:

  • Flucytosine is an antimetabolite.
    Griseofulvin binds to polymerized microtubules and inhibits fungal mitosis.
    Fluocinonide
    Gentian Violet
    Ciclopirox is a fungicidal
    Tolnaftate is a fungicidal

Alternatives:

  • Tea tree oil -- ISO 4730 ("Oil of Melaleuca, Terpinen-4-ol type")

Dandruff shampoos

Antifungal drugs are often found in dandruff shampoos. Among the most common are pyrithione zinc and selenium sulfide.


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