59438711-Antifungal-Agents.pdf

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Department
Microbiology and Immunology
Course
Microbiology and Immunology 3300B
Professor
Garrison
Semester
Fall

Description
Antifungal Agents Fungal Infections Polyene groupʹ Amphotericin B, Nystatin Superficial Systemic MOA Skin Affecting body as whole Interact with ergosterol (component of cell membrane) Hair (eg. AIDS patients) Produce hydrophilic channels Nail Life-threatening Leakage of cell contents & electrolytes Mucous membranes Opportunistic mycoses y Intracellular ion loss Causative fungus y Disrupt osmotic function of membrane (alter cell metabolism) y Candida Amphotericin B Nystatin y Aspergillus Broad spectrum Active against y Cryptococcus Powerful but toxic y Candida Candida albicans Candida spp, aspergillus, Histoplasma y Cryptococcus y Oral lesion capsulatum, C. imitis, Blastomyces y Histoplasma y Oral thrush (candidiasis) dermatitidis, Cryptococcus neoformas Highly toxic y Denture stomatitis Intravenous Used mainly for superficial fungal y Test dose infections ʹ candida Antifungal Drugs y Infusion over 6h Available as Systemic Drugs Topical Therapy y 4h vs 1h y Tablets Highly protein bound Oral/ parenteral 16 Agents y Suspensions y Systemic infections Most common Poor CSF penetration (2-3%) y Vaginal pessaries y Mucocutaneous infections y Clotrimazole (may need intrathecal administration) y Cream Slow release from peripheral 8 Agents y Miconazole Most common y Nystatin compartment y Amphotericin B Slow excretion in urine & bile Adverse Effects y Fluconazole y Itraconazole Immediate (infusion related) y Ketoconazole y Fever, rigors (6%), hypotension y Premed with PCM or steroid Classifications may help Delayed Polyene y Nephrotoxic y Amphotericin B y Nystatin y Electrolyte disturbance (hypokalemia, Azoles hypomagnesemia) y Imidazoles ʹ Ketoconazole, Miconazole, Clotrimazole y Triazoles ʹ Itraconazole, Fluconazole, Voriconazole y Normochromic normocytic anaemia Echinocandins Lipid formulationʹ љ Side effects y Caspofungin y Micafungin Liposomal Ampho B Ampho B in lipid deliveryvehicle y Anidulafungin
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