Classification of Antifungal Agents

1. Azoles: Fluconazole, Itraconazole, Voriconazole

2. Polyenes: Amphotericin B, Nystatin

3. Echinocandins: Caspofungin

4. Allylamines: Terbinafine

5. Other Antifungals: Griseofulvin

Fluconazole

Indications: Treatment of candidiasis, cryptococcal meningitis, prophylaxis in immunocompromised patients.

Dosage:

• Candidiasis: 6-12 mg/kg/day (depending on severity).
• Cryptococcal meningitis: 12 mg/kg on the first day, then 6-12 mg/kg/day.

Contraindications: Hypersensitivity to fluconazole or other azoles.

Adverse Effects: Nausea, headache, abdominal pain, rash.

Special Note: Use with caution in patients with renal or hepatic impairment; monitor liver function tests.

Amphotericin B

Indications: Treatment of severe systemic fungal infections (e.g., aspergillosis, cryptococcosis, mucormycosis).

Dosage:

• 0.25-1 mg/kg/day (depending on formulation and severity of infection).

Contraindications: Hypersensitivity to amphotericin B.

Adverse Effects: Nephrotoxicity, infusion-related reactions (fever, chills), electrolyte imbalances.

Special Note: Monitor renal function and electrolytes closely; liposomal formulations are less nephrotoxic.

Caspofungin

Indications: Treatment of invasive candidiasis, aspergillosis (refractory to other treatments).

Dosage:

• Loading dose: 70 mg/m² on day 1, then 50 mg/m²/day (max 70 mg/day).

Contraindications: Hypersensitivity to caspofungin.

Adverse Effects: Fever, phlebitis, hepatic effects, rash.

Special Note: Adjust dose in patients with moderate hepatic impairment; monitor liver function.

Itraconazole

Indications: Treatment of systemic mycoses (e.g., histoplasmosis, blastomycosis), onychomycosis.

Dosage:

• 5-10 mg/kg/day (divided into two doses).

Contraindications: Hypersensitivity to itraconazole or other azoles, heart failure.

Adverse Effects: Nausea, vomiting, headache, hepatic toxicity.

Special Note: Monitor liver function tests; absorption is increased with food and acidic beverages.

Voriconazole

Indications: Treatment of invasive aspergillosis, candidemia, serious fungal infections caused by Scedosporium and Fusarium species.

Dosage:

• Loading dose: 6 mg/kg every 12 hours for 2 doses, then 4 mg/kg every 12 hours.

Contraindications: Hypersensitivity to voriconazole or other azoles.

Adverse Effects: Visual disturbances, hepatotoxicity, rash, nausea.

Special Note: Monitor liver function and renal function; adjust dose in hepatic impairment.

Griseofulvin

Indications: Treatment of dermatophytosis (ringworm, athlete’s foot, jock itch).

Dosage:

• 10-20 mg/kg/day (in single or divided doses).

Contraindications: Hypersensitivity to griseofulvin, severe liver disease, porphyria.

Adverse Effects: Headache, nausea, vomiting, photosensitivity, rash.

Special Note: Best absorbed with fatty foods; avoid in patients with severe liver impairment.

Nystatin

Indications: Treatment of cutaneous, oral, and intestinal candidiasis.

Dosage:

• Oral candidiasis: 100,000 units/ml suspension, 1-2 ml four times daily.
• Cutaneous candidiasis: Apply cream or ointment two to three times daily.

Contraindications: Hypersensitivity to nystatin.

Adverse Effects: Rarely causes gastrointestinal upset or skin irritation.

Special Note: Oral suspension should be swished and swallowed for oral candidiasis.