C H A P T E R 1 1
Antifungal agents
157
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Fungi can cause many different infections in humans.
■■
Fungi differ from bacteria in that a fungus has a
rigid cell wall that is made up of chitin and various
polysaccharides and a cell membrane that contains
ergosterol.
■■
Systemic antifungal drugs can be very toxic; extreme
care should be taken to ensure that the right drug
is used to treat an infection and that the person is
monitored closely to prevent severe toxicity.
■■
Systemic antifungals are associated with many
drug–drug interactions because of their effects on
the liver. Monitor a person closely when adding or
removing a drug from a drug regimen if the person is
receiving a systemic antifungal.
KEY POINTS
TOPICAL ANTIFUNGALS
Some antifungal drugs are available only in topical
forms for treating a variety of mycoses of the skin and
mucous membranes. Some of the systemic antifungals
are also available in topical forms. Fungi that cause
these mycoses are called
dermatophytes.
These diseases
include a variety of
tinea
infections, which are often
referred to as ringworm, although the causal organism
is a fungus, not a worm. These mycoses include tinea
infections such as athlete’s foot (tinea pedis), jock itch
(tinea cruris) and yeast infections of the mouth and
vagina often caused by
Candida.
Because the antifungal
drugs reserved for use as topical agents are often too
toxic for systemic administration, care is necessary when
using them near open or draining wounds that might
permit systemic absorption. Topical antifungals include
the azole-type antifungals—butoconazole (
Gynazole
),
clotrimazole (
Canesten
,
Clonea
), econazole (
Pevaryl
),
ketoconazole (
Nizoral
), miconazole (
Daktarin
,
Resolve
)
and terbinafine (
Lamisil
)—and other antifungals—
ciclopirox (
Stieprox
), gentian violet (generic), tolnaftate
(
Mycil
,
Tinaderm
,
Tineafax
) and undecenoic acid
(
Gordochom
). (See Table 11.2.)
■
■
Evaluate the effectiveness of the teaching plan
(person can name the drug, dosage, possible
adverse effects to watch for and specific measures
to help avoid adverse effects).
■
■
Monitor the effectiveness of comfort and safety
measures and compliance with the regimen.
TABLE 11.2
DRUGS IN FOCUS Topical antifungals
Drug name
Dosage/route
Usual indications
Azole topical antifungals
butoconazole (Gynazole)
Vaginal cream; applied only once a day for
4 weeks
Available over-the-counter (OTC) for
treatment of vaginal Candida infections
clotrimazole
(Canesten, Clonea)
Available OTC as a cream, lotion, or solution;
applied as a thin layer twice a day for
2–4 weeks
Available OTC for treatment of oral
and vaginal Candida infections; tinea
infections
econazole (Pevaryl)
Applied to affected wet body on three
consecutive evenings
Treatment of tinea, candidiasis of skin or
external genitalia
ketoconazole (DaktaGOLD
Nizoral, Sebizole)
Available in cream, gel, foam, and shampoo
form; applied once to twice daily for
2–4 weeks
Treatment of seborrhoeic dermatitis, tinea
corporis, tinea cruris, tinea pedis
miconazole (Daktarin,
Resolve)
Available as an OTC product in several topical
forms (vaginal suppository, cream, powder,
solution, ointment, gel and spray); applied
twice daily for 2–4 weeks
Treatment of local, topical mycoses,
including bladder and vaginal infections
and athlete’s foot
terbinafine (Lamisil)
Available as a cream or gel; used for
1–4 weeks; applied twice daily
Short-term (1–4 weeks) treatment of
topical mycosis; treatment of tinea
infections
Other topical antifungals
ciclopirox (Stieprox)
Available as a liquid for use as a shampoo
Treatment of dandruff, seborrhoeic
dermatitis
tolnaftate (Mycil,
Tinaderm, Tineafax)
Available as a cream, solution, gel, powder, and
spray; applied twice a day for 2–4 weeks
Available OTC for treatment of athlete’s
foot, topical fungal infections, tinea
undecenoic acid
(Gordochom)
Available as a solution
Treatment of onychomycosis, cutaneous
fungal infections
