Anti Fungal

ANTI FUNGAL REVIEW

MYCOSIS ?

SUPERFICIAL MYCOSIS SYSTEMIC MYCOSIS

CLASSIFICATION • DRUGS FOR SYSTEMIC MYCOSIS Amphotericin B AZOLES Fluconazole Itraconazole ketoconazole Flucytosine

DRUGS FOR MUCOCUTANOUES MYCOSIS

GRISEOFULVIN

TERBINAFINE

DRUGS FOR SUPERFICIAL MYCOSIS Nystatin Clotrimazole Miconazole Econazole

SUPERFICIAL MYCOSES Dermatophyte infections • Ring worms • tinea Candida infections •Cutaneous •Moucosa Alimetary tract. • vaginal

Infection

Superficial mycoses Drugs Route

Imidazoles Ring worm Clotrimazole Econazole Tinea Miconazole Sulconazole

Topical Topical Topical Topical Topical

Candida Infections

Cutaneous

amphotericin

Topical

Clotrimazole

Topical

Econazole

Topical

Miconazole

Topical

Nystatin

Topical

Candida Infections amphotericin Mucosa Fluconazole Alimentary ketoconazole tract Miconazole Nystatin

IV Orally / IV Only Orally Lozenges / Gel / Suspension or tablets

Candida Infections Clotrimazole Econazole Vaginal

Isoconazole ketoconazole Miconazole Nystatin

Pessaries Vaginal tablets cream

Systemic mycosis Aspergillosis Candidiasis Coccidiodoidomycosis Cryptococcosis Histoplasmosis Sporotrichosis

Classification of anti fungal drugs according to Mechanism of action

Drugs that disrupt the cell membrane Drugs that inhibit mitosis

Drugs that disrupt cell membranes

• Polyene antibiotics •Amphotericin B •Nystatin

AZOLES Imidazoles

Triazoles

Ketoconazole Miconazole Clotrimazole Isoconazole Ticonazole Fluconazole Itraconazole

Mechanism of action • Polyene antibiotics Binds to sterols (ergo sterol) present in the cell Membranes Leakage of intracellular ions & enzymes Cell death

Azoles • Imidazoles (KIMC) Interfere with fungal oxidative enzymes Lethal accumulation of hydrogen peroxide Triazoles (FI) Inhibit demethylase enzyme damage cell membrane

Drugs that inhibit Mitosis • Griseofulvin • Flucytosine

Flutycosine

5 flurouracil

Inhibit nucleic acid synthesis