The incidence of fungal infections has been increasing in the human population over the last 15 years, majorly due to increased numbers of cancers and immune-compromised patients, who are at great risk owing to deteriorated immune systems. Antifungal therapy was previously restricted to the systemically active azoles (such as fluconazole, imidazole and ketoconazole) and the broad-spectrum but toxic antifungal drug amphotericin B.
Also, a new azole antifungal, voriconazole, and a new class of antifungals, the echinocandins, have been introduced into the pharmaceutical industry, putting forward more options of treatment, and reduced toxicity compared with conventional amphotericin B. A number of antifungal drugs are either too toxic or otherwise unsuitable for systemic administration, but they can be used topically to treat fungal infections of the skin and mucous membranes.
Treatment of candidal infections of the skin is possible with topical imidazoles (such as clotrimazole, econazole, ketoconazole, etc.), topical terbinafine or nystatin.
Dermatophyte infections of the skin can be treated with a topical imidazole antifungal such as clotrimazole or miconazole in cream form or by using a shampoo containing an antifungal such as ketoconazole. Topical therapy with amorolfine, tioconazole and undecenoate-containing nail lacquers, paints and creams can treat nail infections in the initial stages of fungal disease.
Systemic antifungal drugs are administered by mouth or by injection to treat fungal infections. Systemic antifungals are used to treat various fungal infections such as histoplasmosis, aspergillosis and blastomycosis,, which can affect the lungs and other organs.


Systemic fungal infections can take a long time to settle completely, so it is usually obligatory to continue medication for several months, or even for a year or longer.
Systemic treatment is indicated in severe, extensive skin infections, or in case of associated systemic infections such as in immune-suppressed people, or in people unresponsive to topical treatment. Aspergillosis, rapidly progressive opportunistic mycoses, is known to most commonly affect the respiratory tract of severely immune-compromised patients and is treated with amphotericin. You will hardly find a woman who has not suffered from vaginal infection at some point in her life. Of late, reformulation of amphotericin B into liposomal delivery systems has improved safety profile for the drug. Creams and liquids gain entry into the cracks and crevices where fungi are known to grow, so they are usually the most effective modality for treating fungal infections on the skin. But certain infections, particularly the infection in spaces between toes, may take up to six weeks for complete cure. Fungal infections that occur inside the body or that do not settle down after treatment with creams or ointments may need to be treated with systemic antifungal drugs. They are also used to treat or prevent fungal infections in immune-compromised people, which include bone marrow or organ transplant patients and people with AIDS.


Systemic drugs such as griseofulvin or terbinafine are used to treat advanced nail infections. Recent studies put forth that mortality rate can be reduced by using combination therapy, or liposomal amphotericin B, in place of amphotericin monotherapy.
Oral administration of itraconazole or ketoconazole can be done in less severe infection and intravenous amphotericin is given for more severe infections. Oral terbinafine is only effective against dermatophyte nail infections and has fungistatic activity against candida albicans. More recently, voriconazole is being used as first-line therapy for serious aspergillus infections and is now considered by most clinical mycologists to be the drug of choice for aspergillus infections in both immune-competent and immune-compromised individuals. Voriconazole is effective in candidal esophagitis and is given as rescue therapy for candidal infections.



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