Anti-fungal agents are classified under two major headings, systematic and topical agents. Only systematic
anti-fungal agents will be discussed in this chapter. Since the discovery in 1955,
amphotericin B has been the cornerstone of anti-fungal treatment. It is active against most species of fungi. However, Candida lusitaniae, Pseudallescheria boydii, and fusarium spp have primary resistance to
amphotericin B. Recently, new liposomal preparations of
amphotericin B have been developed. They are less nephrotoxic. The
azole family of anti-fungal includes two broad classes: the
imidazoles (clotrimazote, ketoconazote,
miconazole) and the
triazoles (flucouazole and itracouazole).
Imidazoles are still widely used for the treatment of superficial
mycoses and vaginal
candidiasis. The systematic
triazoles are more slowly metabolized and have less effect on human synthesis than
imidazoles, hence they are preferred for systemic
therapy.
Flucytosine is a fluorinated
pyrimidine. Clinically, the principal use of
flucytosine is as adjunctive
therapy with
amphotericin B in the treatment of candidial or cryptococcal diseases, Griseofuluin is derived from penicillium. It is fungistatic in vitro for species of dermatophytes. It is useful for the treatment of
tinea capitis and
tinea unginum.