Antifungal drugs

Miconazole is an imidazole antifungal with similar antimicrobial activity to that of ketoconazole. It also has some activity against Aspergillus spp., Cryptococcus neoformans, Pseudallescheria boydii, and some Gram-positive bacteria including staphylococci and streptococci.

Ketoconazole has a wide spectrum of antimicrobial activity including activity against Blastomyces dermatitidis, Candida spp., Coccidioides immitis, Epidermophyton floccosum, Histoplasma capsulatum, Malassezia spp., Microsporum canis, Paracoccidioides brasiliensis, Trichophyton mentagrophytes, and T. rubrum. Some strains of’Aspergillus spp., Cryptococcus neoformans, and Sporothrix schenckii are sensitive.

Sporanox (Itraconazole) is active against Aspergillus spp., Blastomyces dermatitidis, Candida spp., Coccidioides immitis, Cryptococcus neoformans, Epidermophyton spp., Histoplasma capsulatum, Malassezia furfur, Microsporum spp., Paracoccidioides brasiliensis, Sporothrix schenckii, and Trichophyton spp. Itraconazole also has some antiprotozoal activity againstLeishmania spp.

Flucytosine is active against Candida spp., Cryptococcus neoformans, Cladosporium spp., and Fonsecaea spp. Some Aspergillus spp. have also been reported to be sensitive.

Econazole is an imidazole antifungal used topically in the treatment of superficial candidiasis and in dermatophytosis and pityriasis versicolor.

Clotrimazole is an imidazole antifungal used topically in superficial candidiasis, and in the skin infections pityriasis versicolor and dermatophytosis (see Skin Infections). Clotrimazole may also be used occasionally for symptomatic relie of the protozoal infection trichomoniasis when other drugs are contra-indicated.

Ciclopirox is an antifungal that is applied topically in the treatment of fungal skin and nail infections, including cutaneous candidiasis, dermatophytosis, pityriasis versicolor (see Skin Infections), and seborrhoeic dermatitis.

Butoconazole is an imidazole antifungal used locally as the nitrate in the treatment of vulvovaginal candidiasis. It is given intravaginally as a 100-mg pessary or as 5 g of a 2% cream for 3 consecutive nights a single application of the cream has also been used.

Bifonazole is an imidazole antifungal with a broad spectrum of activity sensitive fungi include dermatophytes, Malassezia furfur, and Candida spp. It also has some antibacterial activity.

Anidulafungin is an echinocandin antifungal active against Aspergillus and Candida spp. It is used in the treatment of candidaemia, oesophageal candidiasis, and other forms of invasive candidiasis.