25. Anti-Fungal Agents

25. Anti-Fungal Agents - Anti-Fungal Agents Anti-Fungal...

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Anti-Fungal Agents Anti-Fungal Agents Agent Oral IV IM Topical Amphotericin B X X X Clotrimazole X X Fluconazole X X Griseofluvin X Itraconazole X Ketoconazole X X Nystatin X X Terbinafine X X Ticonazole X Anti-Fungal Agents • Fungal infections fall into two general groups: – superficial infections that can be treated with topical agents (Clotrimazole, Econazole, Griseofluvin, Miconazole, Nystatin) – systemic infections which are often chronic and life threatening (Amphotericin B, Fluconazole, Flucytosine, Itraconazole, Ketoconazole) Anti-Fungal Agents • Fungi are eukaryotes-- therefore there are a limited number of sites of action available • Fungi have rigid cell walls made of chitin and polysaccharides and a cell membrane that contains ergosterol • Anti-bacterial agents do not work on fungi and vice versa. Amphoteracin B • It is a naturally occurring polyene macrolide antibiotic (from Streptomyces nodosus ) • The drug of choice for systemic mycosis • It is sometimes used in combination with flucytosine so that less amphoteracin B (toxic!) is needed. Amphotericin B • Mode of action: – Ampho B binds to ergosterol present in cell membranes – Ampho B forms pores in the membrane that allow small molecules (salts, etc) to leak out, resulting in cell death – Ampho B prefers ergosterol to cholesterol (found in mammals), but is not completely specific! – Can be either fungicial or fungistatic depending on the organism – covers a wide range of fungi
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Amphotericin B • Adverse effects: – Resistance can result from reduced ergosterol in the membrane
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25. Anti-Fungal Agents - Anti-Fungal Agents Anti-Fungal...

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