education

1. ANTIFUNGAL DRUGS
Dr. Dilip kumar singh
JR 1
Pharmacology and Therapeutics
KGMU Lucknow

3. FUNGAL INFECTION
classification:
• Superficial infections
Skin and mucous membrane
Incidence rate is high
e.g. Ringworm (tinea)
Systemic infections:
opportunistic infections
Fatality rate is high
e.g. Candida albicans, Histoplasma

4. Antifungal agents classification
• Based on structure:
1) Antibiotics:
Polyenes: Amphotericin B, Nystatin
Heterocyclic Benzofuran: Griseofulvin
Echinocandins: Caspofungin
2) Azole Topical- Clotrimazole, Miconazole
a) Imidazoles
Systemic- Ketoconazole

5. Antifungal agents classification……
B. Triazoles: Fluconazole, Itraconazole, Voriconazole
3) Allylamine: Terbinafine
4) Antimetabolite: Flucytosine
5) Other Topical: Benzoic acid, Quiniodochlor,
Sod.thiosulfate

14. Antifungal spectrum
• Broadest spectrum antifungal
• Fungicidal at high and fungistatic at low concentration
• Active against most of Fungi-
e.g. Candida albicans, Histoplasma capsulatum
Aspergillus, Cryptococcus neoformans…
• AMB also active against various species of Leishmania

16. Adverse effect
• Toxicity of Amphotericin-B is high
Acute reaction:
Occurs with each infusion these are-
 Chills , fever , body aches, ,nausea, vomiting
Dyspnoea (lasting for 2 to 5 hrs)
Inj. Hydrocortisone 0.6 mg/kg with infusion may reduce the
intensity of reaction

17. Adverse effect…..
Long term toxicity:
• Nephrotoxicity- most important, dose related
-Azotemia, ↓ GFR, acidosis, hypokalaemia
Anaemia, inability to conc. urine
• CNS Toxicity- Occurs only on intrathecal injection
Headache, vomiting, nerve palsies etc.
• Hepatotoxicity some time

20. Pharmacokinetics
• Irregular oral absorption due to very low water solubility
• ↑ by taking with fat and microfine particle
• Get concentrated in keratinized tissue
• Metabolised in liver
• Excreted in urine
• Plasma half life 24 hr

25. AZOLES
• Synthetic antifungal ,Broad spectrum
• Most commonly used
• Both fungistatic and Fungicidal depending on conc.
• Classified in two groups
• IMIDAZOLE TRIAZOLE
2 Nitrogen in structure 3 Nitrogen in structure
• Both have same mechanisms of action

42. THANK YOU