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Classification of Antifungal Drugs

Antifungal drugs are classified based on their mechanism of action and the type of fungal infections they treat. These drugs are primarily used to treat various fungal infections ranging from superficial to systemic infections.

1. Polyene Antifungals

  • Examples: Amphotericin B, Nystatin
  • Mechanism of Action: Bind to ergosterol in the fungal cell membrane, forming pores that increase permeability, leading to cell death.
  • Therapeutic Uses: Severe systemic infections like candidiasis, aspergillosis, and cryptococcosis.
  • Adverse Effects: Nephrotoxicity, fever, chills, hypotension, and anemia.

2. Azoles

  • Examples: Fluconazole, Itraconazole, Ketoconazole, Voriconazole
  • Mechanism of Action: Inhibit lanosterol 14-α-demethylase, disrupting ergosterol synthesis and impairing cell membrane formation.
  • Therapeutic Uses: Treat a wide range of fungal infections, including candidiasis, dermatophytosis, and onychomycosis.
  • Adverse Effects: Hepatotoxicity, GI disturbances, skin rash, and drug interactions due to cytochrome P450 inhibition.

3. Echinocandins

  • Examples: Caspofungin, Micafungin, Anidulafungin
  • Mechanism of Action: Inhibit β-(1,3)-D-glucan synthesis, causing disruption of the fungal cell wall.
  • Therapeutic Uses: Invasive candidiasis and Aspergillus infections.
  • Adverse Effects: Hepatotoxicity, fever, and phlebitis at the injection site.

4. Allylamines

  • Examples: Terbinafine, Naftifine
  • Mechanism of Action: Inhibit squalene epoxidase, leading to ergosterol depletion and toxic accumulation of squalene in the fungal cell.
  • Therapeutic Uses: Treat dermatophytosis, onychomycosis, and tinea infections.
  • Adverse Effects: Hepatotoxicity, GI disturbances, and skin reactions.

5. Flucytosine

  • Mechanism of Action: Converted to 5-fluorouracil in fungal cells, inhibiting DNA and RNA synthesis.
  • Therapeutic Uses: Combination therapy for systemic fungal infections like cryptococcal meningitis.
  • Adverse Effects: Bone marrow suppression, hepatotoxicity, and GI disturbances.

6. Griseofulvin

  • Mechanism of Action: Binds to microtubules, inhibiting fungal cell division.
  • Therapeutic Uses: Treats dermatophyte infections such as ringworm and tinea.
  • Adverse Effects: GI disturbances, hepatotoxicity, and photosensitivity.