Antimycotic agents for topical use. Review of modern antifungal drugs in tablets. Antifungal drugs for children

Antifungal medications Medicines in the form of tablets and capsules

Indications for use

Treatment of mycoses with antifungal drugs in broad-spectrum tablets is indicated for:

• The course of an unspecified infection (the symptoms of the disease are identical to a fungal infection, but it is impossible to determine the pathogen strain in the laboratory);
• Mixed fungal infection;
• A large area of ​​fungal skin infection with the formation of ulcers, ulcers, and exfoliations;
• Frequent relapses of extremity fungus (onychomycosis, dermatomycosis, candidiasis);
• Lack of a positive trend of recovery with local fungal therapy;
• Chronic (seasonal) exacerbation of fungal infection;
• Development of fungus against the background of immunodeficiency (HIV, AIDS);
• Leishmaniasis;
• There is a high risk of infection with a fungus as a preventive measure if one of the family members is sick.

Classification of antimycotics

Tablets for fungal infections are divided into two types, containing:

• Natural ingredients;
• Chemical synthesized elements.

The first type of tablet is more gentle on the body, the second type provides high resistance to fungus.

Depending on the degree of activity and clinical use, tablet preparations for fungus are classified into the following groups.

Polyene

Includes antibiotic tablets of natural origin with an antimycotic spectrum of action against yeast (Candida), yeast-like, mold (Aspergillus) fungi, cryptococci, sporothrix, dermatomycetes, pseudoallescheria boydi.

Active ingredient in anti-fungal medications:

• Nystatin;
• Levorinum;
• Natamycin;
• Neomycin;
• Amphotericin.

The main components of the tablets bind sterols to the membranes of spore cells, which leads to inhibition of fungal activity.

Azole

The azole synthetic series of tablets is active against yeast (Candida), mold (Aspergillus) fungi, dermatomycetes, sporothrix, Pseudoallecheria boydi, dimorphic (Histoplasma) fungi, dermatomycetes, blastomycetes, cryptococci, coccidioides.

Active ingredient of antifungal tablets:

• Ketoconazole;
• Itraconazole;
• Fluconazole.

Allylamine

Synthetic antimycotics in tablets have an inhibitory effect on yeast (candida, chromomycosis), mold (aspergillus), dimorphic (histoplasma) fungi, blastomycetes, sporothrix, cryptococci.

The active ingredient of allylamine preparations, terbinafine, inhibits the division of fungal cells and destroys them from the inside in the first minutes of entry into the body.

The broad spectrum of action of antifungal tablets (capsules) can be explained by the negative impact of their components not only on fungal infections caused by various pathogens, but also on the reproduction of simple microorganisms - amoebas, trichomonas, trypanosomes, leishmania.

Fungicidal substances of antifungal agents with proven effectiveness are included in combined antiseptic and bactericidal drugs, despite the fact that they tend to enhance or inhibit the effect of other drugs.

Contraindications for use

Systemic antifungal medications in tablet form are characterized by the following contraindications:

• Pregnancy;
• Lactation;
• Child age limit;
• Diseases of the liver, kidneys, gastrointestinal tract, cardiovascular system;
• Diabetes;
• Allergy to the components of the tablets.

Rules for the use of fungicidal tablets

The effectiveness of therapy for mycoses with broad-spectrum antifungals is determined by:

• Determination of the pathogen - fungal strain;
• A doctor's prescription authorizing the use of a certain type of pill;
• Compliance with the dosage regimen (regularity, dose, time interval, duration of the treatment course);
• Take medications with food and drink plenty of liquid.

Antifungal antibiotics in tablets (capsules) used in the treatment of mycoses, characterized by fungicidal and fungistatic effects, are relatively toxic. There is no other alternative to these drugs, so they must be used with extreme caution.

Even if you follow the instructions for taking antifungal agents, adverse reactions may occur:

• Dizziness;
• Gastrointestinal tract dysfunctions;
• Increased excitability;
• Active reproduction of the fungus instead of inhibition;
• Allergic reaction.

Taking tableted antifungal agents is incompatible with consuming alcohol-containing products.

Drug treatment of mycoses

The group of antifungal antibiotics in tablets (capsules) on the domestic pharmaceutical market is represented mainly by original drugs, the name of which is identical to the active substance. Intended for the treatment of adults and children.

Natomycin

Commercial name Pimafucin. The most affordable drug (360 rubles for 1 pack of 20 pcs.). Prescribed for intestinal candidiasis. The therapeutic course lasts no more than one week. The dose is determined depending on the age of the patient.

Nystatin

An antifungal drug from a number of available ones (550 rubles for 1 pack of 20 pcs.). It is prescribed mainly for candidiasis. The course of treatment with tablets does not exceed two weeks. Dosage is determined according to age scale. It is used in the treatment of mycoses and their prevention.

Levorin

It belongs to the group of expensive antifungal drugs (700-900 rubles for 1 pack of 25 pcs.). The medicine is prescribed for oral administration in case of candidiasis in order to prevent the disease, as well as for severe symptoms of genital candidiasis and intestinal candidiasis. The course of treatment with tablets is from 15 days to three months. The dosage of the medicine depends on the age of the patient and the severity of the disease.

Amfo-Moronal

The active ingredient is amphotericin B. The most expensive polyene (5600 rubles for 1 pack of 20 pcs.). The medicine is prescribed for severe mycoses (trichosporosis, histoplasmosis, penicilliosis, aspergillosis, sporotrichosis, phaeohyphomycosis, blastomycosis, paracoccidioidosis). The course of treatment for fungus is from two weeks to a year. The dosage is prescribed according to age.

Nizoral

The active ingredient is ketoconazole. The cost of the drug is 1260 rubles for 1 pack. 30 pcs. Prescribed tablets for the diagnosis of chromomycosis, blastomycosis, histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, also for mycoses of the hands and feet in cases of dermatitis and cutaneous candidiasis, when local therapy is powerless. The dosage is prescribed depending on the patient’s body weight and age. The duration of the therapeutic course with tablets is up to six months or more.

Orungal

The active substance is itraconazole. Price 1 pack. antifungal capsules 14 pcs. – 3000 rubles. Prescribed tablets for yeast and dermatophyte onychomycosis of the nails, skin candidiasis, unspecified strain of fungus, histoplasmosis, sporotrichosis, blastomycosis, pityriasis versicolor. The tablets are taken in courses, the duration of one is one to three weeks. The number of courses depends on the complexity of the disease and can exceed six months. The dosage and frequency of taking the drug are determined depending on the age of the patient.

Diflucan

The active substance is fluconazole. 1 pack 14 pcs. costs at least 2000 rubles. Capsules are prescribed for fungus of the nails, feet, hands, torso, unspecified, chronic mycosis, candidiasis of varying complexity, cryptococcosis, epidermophytosis. The course of treatment for fungus with this drug is four to eight weeks. The dose is determined depending on the age of the patient.

Terbizil

The active ingredient is terbinafine. Price 1 pack. 14 pcs. tablets 1600 rubles. The drug is prescribed for nail mycosis, onychomycosis, cutaneous candidiasis of the trunk and nails, and fungus of the scalp. Depending on the degree of fungal damage, the course of treatment with tablets can last from one to three months. The dose of the drug is calculated according to the patient’s age.

Analogues of antimycotics

The price of original antimycotics significantly exceeds the cost of analogues. The table shows samples of inexpensive but effective antifungal tablets.

Analogue drug	price, rub.	Expensive original (active ingredient)
Dermazol	300	Nizoral (ketoconazole)
Mizoral	550
Ketoconazole	140
Irunin	600	(itraconazole)
Itrazole	1300
Orunite	580
Kanditral	960
Fluconazole	70	Diflucan (fluconazole)
Diflucan (fluconazole)	400
Mycomax	400
Diflazon	100
Mikosist	600
Exiter	340	Terbizil (terbinafine)
Terbinafine-MFF	150
Thermikon	350

A separate group of low-cost antifungal drugs intended for the treatment of severe mycoses includes the drug Griseofulvin. A package of tablets (20 pcs.) costs 240 rubles. Griseofulvin therapy is effective in the diagnosis of epidermophytosis, dermatitis, trichophytosis, microsporia of hair and nails. The course of treatment for advanced fungus with these tablets is two to four months.

Antifungal drugs are available in pharmacies without a prescription, but it is not recommended to use them without a prescription from a dermatologist.

Oral candidiasis is a characteristic mucosal lesion caused by a fungal infection of the genus Candida albicans.

The cause of the disease is a general decrease in immunity, which contributes to the proliferation of fungal infections. causes itching and burning in the mouth, as well as other unpleasant symptoms; modern antifungal drugs are used to treat it.

Medicinal complex to combat fungus

Antifungal agents are drugs that have a direct antifungal effect aimed at preventing further growth (fungistatic effect) or completely eliminating the pathogen (fungicidal effect). Antimycotics are prescribed both for the prevention of the disease and for the treatment of all forms.

Modern antimycotics are divided into:

• polyene antibiotics, causing destruction of the fungal cell through penetration into its membrane and metabolic disorders (Natamycin, Amphotericin B, Levorin, Nystatin are most effective for candidiasis);
• imidazoles, blocking certain enzymes necessary for the functioning of the fungal cell. These include Miconazole, Imidazole and Clotrimazole;
• bis-quaternary ammonium compounds(Decamin) also have an antifungal effect and are used both locally on the lesion and in systemic therapy;
• echinocandins(Caspofungin, Micafungin) inhibit the synthesis of fungal polysaccharides used to build the cell wall.

Antiseptics are used as rinses to prevent the spread of infection and to sanitize existing foci of inflammation. Such means include solutions and. The mucous membranes are also lubricated with solutions and Resorcinol.

To prevent the disease, vitamin therapy is used to stimulate the immune system, taking into account the replenishment of the deficiency of groups A, C, E, B1, B2, B6.

What you need to know about antifungal agents: pharmacological features, classification, nuances of use:

Products for the treatment of adult patients

The goal of therapy is to simultaneously influence the infection from several points of application. This is a local suppression of infection, the essence of which is the application of antimycotics and other drugs directly to the lesions of the affected oral mucosa, and systemic treatment of candidiasis by taking antibiotics.

Topical products

It begins with the use of medications whose action is aimed at sanitation of the oral cavity. As a rule, aniline dyes can be used for this:

Systemic therapy

For the systemic treatment of candidiasis in adult patients, the following medications are used:

Treatment of children and infants

It is more complex in terms of drug selection; there is only a limited list of approved drugs, among which hydroxyquinoline-8 and -4 derivatives, quaternary ammonium compounds and herbal remedies are used for topical use.

Local effect on fungus

Permitted means include:

Systemic therapy

For systemic exposure the following are used:

Remedies for the treatment of candidiasis of the throat and tonsils

The affected areas of the throat and tonsils must be treated with antiseptic agents moistened with a cotton swab. For this purpose:

1. Copper sulfate solution. Acts as a disinfectant astringent. Use a solution with a concentration of 0.25%. Treatment of mucosal areas occurs three times a day until the clinical manifestations of the fungal infection completely disappear.
2. 20 % . Apply to areas of the affected mucous membrane of the throat and tonsils to eradicate fungal infections.
3. . Has the same properties as other solutions.
4. Resorcinol. A 0.5% solution is used for application to the mucous membrane of the throat. In rare cases, allergic reactions are possible.
5. Fukortsin solution. May cause temporary local burning and pain. Apply 2 to 4 times a day.
6. Silver nitrate solution. Has a bactericidal and anti-inflammatory effect. For application to the mucous membranes of the oral cavity, 2% liquid is used.

Local treatment must be accompanied by systemic therapy, which includes the following medications:

Also, for laryngeal candidiasis, physiotherapeutic measures with alternating procedures every two days are effective.

Editor's Choice

Among all the variety of medications, it is difficult to choose the best anti-candidiasis drugs in terms of effectiveness and safety, but we tried to do it. Our TOP 5:

1. Flucanazole. The drug has a systemic inhibitory effect on the synthesis of biological compounds of the fungal membrane, resulting in its destruction. It has a wide spectrum of action and a low degree of toxicity.
2. . It does not have accumulative properties in the body, which reduces the risk of side effects. Popular with doctors and patients.
3. Amphotericin B. Inhibits all types of fungi. Widely used in pediatrics and has almost no side effects.
4. . The drug can be used in large quantities without the risk of adverse reactions. Interacts with all antifungal drugs.
5. Ketoconazole. Prescribed for both external and internal use. Its dosage allows you to use the drug once a day.

Any antifungal drugs should be prescribed by the attending physician and only after examination and diagnosis. Thus, when prescribing a particular remedy, the specialist will take into account concomitant diseases, individual susceptibility and the severity of candidiasis.

When taking medications, you must follow the recommended dosage to avoid side effects. Treatment should be comprehensive and consist of several types of therapy (local and systemic).

It must be remembered that treatment must be continued, and its interruption can lead to relapse of the disease. If side effects of any complexity occur, you should contact your doctor to adjust the therapy and eliminate the symptoms that appear.

Candidiasis requires special attention, modern treatment and accurate diagnosis. At the moment, there are many groups of drugs that are individually selected depending on the severity of the disease, concomitant pathologies or existing contraindications.

This type of fungal infection, if the treatment rules are followed, disappears forever, without recurrence or complications.

Antifungal drugs are used to treat infectious diseases caused by fungi. Fungi can settle on the skin, scalp, nails, both hands and feet, as well as in the vagina and gastrointestinal tract. There they cause a variety of lesions and often become a source of serious problems, especially for people with weakened immune systems.

Today there is a wide selection of different antifungal agents for topical use. It is almost impossible to choose such a drug on your own, since you first need to make a correct diagnosis, and only then choose the most effective remedy. A doctor will help you navigate the widest choice and choose the right medicine, and it is prohibited to transfer your medicine to other people.

What are the local antimycotics?

The group of antimycotics or antifungal drugs includes a wide variety of chemical compounds. They come in both natural and chemical origin. All these substances have specific activity against certain classes of pathogenic fungi.

Antimycotics include different substances with different chemical structures, which allows them to be divided into groups. Each group has its own spectrum of activity. The pharmacokinetics and features of clinical use for various fungal infections also differ.

The group of polyenes includes drugs such as Levorin, Nystatin, Natamycin, Amphotericin B, Amphotericin B liposomal. The azoles group includes both drugs for topical use and drugs for the systemic treatment of mycoses. Azoles for systemic use are Fluconazole, Ketoconazole, Itraconazole. Azoles for topical use include Clotrimazole, Econazole, Miconazole, Isoconazole, Bifonazole, Oxiconazole. The allylamine group also includes drugs for topical and systemic use. The drug Terbinafine is used for systemic use, and Naftifine for local use. In addition, there are also drugs for systemic use such as Griseofulvin and Potassium iodide, and Amorolfine and Ciclopirox for systemic use.

It is very easy to become infected with fungus - even handrails in transport can become a source.

Recently, the need for the use of antifungal drugs has increased significantly, as the prevalence of systemic mycoses has increased. This is due to an increase in the number of patients with immunosuppression of various origins. Invasive medical procedures and the use of powerful, broad-spectrum treatments are also much more common.

Features of treatment

Topical antifungals usually come in a variety of easy-to-use forms. They can be purchased in the form of classic ointments, as well as creams, powders, drops or liquids, suppositories and shampoos. The products must be used according to the doctor's instructions and the instructions on the package.

When treating with antifungal agents, it is very important not to interrupt the recommended course of treatment. Even if the symptoms have already disappeared and nothing reminds you of the disease, the course of treatment must be continued for at least a week. The only exceptions may be vaginal tablets or suppositories, which can be used until the symptoms disappear. If you do not follow this rule, a relapse of the infection may occur.

Adults are much more likely to get foot fungus than because they have thicker skin and calluses, which are an excellent breeding ground for the fungus.

Special forms of medications are available to treat fungal infections in the vagina. These can be vaginal tablets or suppositories, as well as vaginal creams.

What are the forms of release of drugs?

All forms of drug release have their own advantages and purpose. Creams and ointments are most often used to treat fungal skin infections. Before using them, the skin is thoroughly cleansed and the product is applied in a thin layer. Rub it in with gentle circular movements until the medicine disappears from the surface of the skin.

Medicines in powder form are usually used to treat fungal infections of the skin between the toes and in the groin. Use the powder between uses of the cream and apply to the affected areas once or twice a day. It is very important to thoroughly dry the affected areas of the skin.

Liquids are intended for treating the skin of the body and scalp. Some need to be applied to the affected areas of the skin and allowed to dry completely. The skin should be treated with such liquids once or twice a day. There are also antifungal body care liquids. They are applied to the affected areas of the skin and remain there for the time specified by the doctor. Then they must be washed off the skin. The course of treatment is determined individually.

If you suspect that you may have become infected with foot fungus, you need to wipe your foot with lemon juice.

In addition, there is a wide range of antifungal shampoos that are commonly used to treat dandruff caused by fungus. Most shampoos are recommended to be applied to damp hair, lathered and left on the hair for 5 minutes. After this, the hair is washed and the procedure is repeated. The course of treatment is determined by the doctor, and after complete recovery, you can periodically check the procedure for prevention.

Antifungals in the form of vaginal suppositories or tablets are inserted into the vagina before bed. The same applies to vaginal creams.

Side effects and precautions

Most antifungal drugs are well tolerated and cause virtually no side effects, but unpleasant consequences are still possible. If redness and itching appear at the site of application of the medicine, which was not there before, or the skin condition worsens, burning and pain appear, you should immediately inform your doctor. It is also possible for irritation and burning in the vagina to occur when using these medications; this situation also requires consulting a doctor.

It is important to use antifungal medications correctly and take all precautions. Do not allow any of the medications to come into contact with your eyes. Be sure to tell your doctor if you have ever had an allergic reaction to any topical medications or any antifungal agents. In general, you should warn any doctor about its presence in order to avoid unpleasant consequences.

Most fungi are very tenacious; they do not die at temperatures up to 100 degrees and can easily live in beach sand for months.

Before using vaginal cream or suppositories, you must notify your doctor if you are pregnant or actively planning one. Most antifungal medications are not contraindicated during pregnancy, but in the first trimester it is still better to refrain from using them.

According to the active chemical group and pharmacological activity in the classification of antifungal drugs, polyene and non-polyene antibiotics, azoles, groups of allylamines, pyrimidines, and echinocandins are distinguished.

They have a systemic effect and are often prescribed for the treatment of mycoses: amphotericin B, griseofulvin, and mycoheptin. For dermatomycosis, antifungal antibiotics griseofulvin, amphoglucamine, and nystatin are used.

They are increasingly being replaced by antifungal agents Lamisil and Orungal. In the treatment of candidiasis, preference is given to antimycotics fluconazole, ketoconazole, levorin, nystatin, miconazole.

Oxiconazole, Griseofulvin, Tolcyclate, Tolnaftate are used against dermatophytes. The drugs of choice are Naftifine, Natamycin, Amorolfine, Terbinafine, Batrafen, Amphotericin B.

In the modern classification of antifungal drugs, polyene and non-polyene antibiotics are distinguished.

Polyene antibiotics

Polyene antifungal antibiotics are used for severe forms of mycoses, in patients with weakened immune systems.

The antifungal antibiotic natamycin belongs to the group of macrolides, has a wide spectrum of action, and is most active against yeast-like fungi. The fungicidal effect of natamycin manifests itself in the destruction of fungal membranes, which causes their death.

Broad-spectrum antifungal suppositories Natamycin, Pifamucin, Primafungin, Ecofucin with natamycin as an active substance are used in the treatment of thrush and cutaneous candidiasis.

Pifamucin is active against mold fungi aspergillus, penicillins, yeast-like candida, cephalosporins, fusarium.

The drug Pifamucin is produced in the form of tablets, cream, vaginal suppositories, the drug is an antifungal drug approved during pregnancy and lactation.

Natamycin is not effective against dermatophthae and pseudoallescheria.

Amphotericin B is prescribed for dermatomycosis, candidiasis of internal organs, mold, and deep mycoses. The drug is available in the form of ointments and solution for injection. Amphotericin B is the active ingredient in Amphoglucamine, Fungizone.

Antifungal drugs Nystatin and Levorin are active against Candida fungi and are used in complex therapy for long-term treatment with penicillin and tetracycline antibiotics.

The antifungal antibiotic mycoheptin has a spectrum of action similar to amphotericin B and is prescribed for mold mycoses, candidiasis, and deep mycoses.

Mycoheptin is toxic; tablets are not prescribed during pregnancy or for children under 9 years of age.

Non-polyene antibiotics

Griseofulvin is an antifungal antibiotic produced by Penicillium nigricans. The greatest effectiveness of the drug is achieved when taken orally.

Griseofulvin inhibits the growth of dermatomycetes fungi and is one of the main drugs in the treatment of trichophytosis, microsporia of the scalp, favus, and nail fungus.

Griseofulvin contains the antifungal agents Gricin, Grifulin, Grifulvin, Fulcin, Fulvin, Grisefulin, Lamoril, Sporostatin.

Griseofulvin is effective when taken orally; in tablet form, this antifungal agent is prescribed for ringworm.

The antifungal agent griseofulvin in the form of a suspension is used to treat children under 3 years of age. Adolescents and adults are prescribed the drug in tablets, the daily dose is calculated based on the patient’s weight.

Griseofulvin is not used for candidiasis and is not prescribed during pregnancy or lactation. The drug has a teratogenic effect; the danger to the fetus remains for a year after treatment with griseofulvin.

Synthetic antimycotics

Modern antifungal agents are synthetic drugs, have a wide spectrum of action, and are used in the local and systemic treatment of mycoses. The group of synthetic antimycotics includes azoles, allylamines, and pyrimidines.

Azoles

Antifungal drugs from this group exhibit fungistatic - suppression of fungal growth - and fungicidal effects.

Fungicidal properties are expressed in the destruction of fungal cells; the effect is achieved only with high concentrations of antimycotics. The azoles group includes:

• ketoconazole, bifonazole, clotrimazole, econazole, miconazole, oxiconazole, butoconazole, isoconazole, sertaconazole, fenticonazole - imidazoles;
• Voriconazole, fluconazole, itraconazole are triazoles.

Among the triazoles, voriconazole and itraconazole have the highest activity.

Antifungal agents containing voriconazole have a wide spectrum of action and are effective in the treatment of aspergillosis, candidiasis, pityriasis versicolor, subcutaneous and deep mycoses.

Voriconazole is included in the composition of Vfend, Voriconazole tablets and powder, Vikand tablets, Biflurin.

Antifungal drugs of this group are used in the treatment of severe fungal infections, long-term use of antibiotics, and in case of risk of fungal infection after organ transplantation.

Antimycotics containing itraconazole have almost the same broad spectrum of activity as drugs containing voriconazole.

They are used in the form of capsules for oral administration in the systemic treatment of mold and candida mycoses of the skin, nail fungus, vulvovaginal candidiasis, and deep mycoses.

Itraconazole is contained in the drugs Itrazol, Itraconazole, Orungal, Rumikoz, Orunit, Itramikol, Kanditral, Teknazol, Orungamin, Irunin.

Antifungal drugs based on fluconazole are effective in the treatment of candidiasis, dermaphytosis, and deep mycoses. But they are not active against mold fungi, a number of Candida fungi.

The active compounds containing fluconazole include Mikosist, Diflazon, Mikoflucan, the combined agent Safotsid, Diflucan, Flucostat, Fungolon, and the antifungal gel Flucorem.

The group of imidazoles includes both antifungal drugs with well-known properties, which have long been used in medical practice, and new drugs.

New synthetic imidazoles effective against candida fungi include the broad-spectrum antifungal drug fenticonazole.

Available in the form of capsules for oral administration, vaginal capsules and Lomexin cream.

The drug treats genital candidiasis in men and women; the cream has antibacterial activity and is used for vaginal trichomoniasis.

The third generation imidazole ketoconazole is close in effectiveness and spectrum of action to itraconazole, but is not active against the mold fungi Aspergillus, as well as some strains of Candida.

Ketoconazole contains antifungal ointments Mycozoral, Perhotal, Sebozol, Mycoquet, Nizoral cream and shampoo, shampoos for people Keto Plus, Mikanisal.

Antifungal drugs with bifonazole as an active ingredient are used primarily for external treatment and exhibit fungicidal and fungistatic activity.

Bifonazole penetrates deeply into the skin, remains in tissues for a long time in therapeutic concentrations, and is available in the form of creams, lotions, gels Kanespor, Bifon, Mikospor, Bifosin, and Bifonazole powder.

The active substance clotrimazole is included in the antifungal agents Candide, Kanizon, Amyclone, Kanesten, Imidil, Lotrimin, Candizol, Clomegel.

The antifungal agent Candid-B is widely used to treat skin mycoses; for thrush in men, Clotrimazole ointment is used.

Preparations containing the antifungal agent sertaconazole have a wide spectrum of action and are used externally for the treatment of mycoses of the skin of the feet, head, beard in men, torso, and skin folds.

Sertaconazole contains Zalain cream, Sertamicol cream and solution, and vaginal suppositories with Optiginal lidocaine.

Comparative Features

In the group of azoles, ketoconazole has the greatest hepatotoxicity; the drug is used mainly for local treatment.

Fluconazole is considered a less toxic azole drug, but it can also cause side effects:

• allergic reactions;
• headache, sleep disturbances, convulsions, blurred vision;
• nausea, vomiting, stool disorders.

Of the azole antifungal drugs, fluconazole is allowed during pregnancy.

It is prescribed for mycoses of various localizations, including the prevention of fungal infections during radiation therapy or treatment with antibiotics.

Allylamines

Representatives of allylamines are the synthetic drugs terbinafine, naftifine. In the classification of antifungal drugs, terbinafine as an active ingredient is included in the new generation of antimycotics.

This group includes antifungal tablets, creams, ointments, skin sprays Lamisil, Exifin, Terbinafine, Fungoterbin, Lamisil Dermgel, Binafin, Atifin, Myconorm, Mycoferon gel.

Terbinafine has a fungistatic and fungicidal effect and is the drug of choice in the treatment of dermatophytosis, candidiasis, chromomycosis, onychomycosis, and deep mycoses.

Preparations with terbinafine are active against all known fungal diseases, as well as against leishmaniasis and trypanosomiasis caused by protozoa.

Antifungal drugs with terbinafine are used for oral administration in tablets for mycoses of smooth skin of the body, legs, head, toenails, and hands.

Medicines with the active ingredient terbinafine are prescribed for the systemic treatment of extensive foci of microsporia, trichophytosis, candidiasis, pityriasis versicolor, and chromomycosis.

Treatment with terbinafine for nail fungus gives a positive result in 93% of cases.

Antifungal drugs containing the active ingredient naftifine include Exoderil cream and solution. Medicines are used to treat skin and nails, applied topically once a day.

Echinocandins

The group of new echinocandin antifungal drugs includes Anidulafungin, Caspofungin, Micafungin. Antifungal drugs echinocandins are not approved for the treatment of children under 18 years of age, during pregnancy, and lactation due to lack of data.

Other groups of antimycotics

Preparations with amorolfine Oflomil Lak, Loceril are used against mycoses of the nails, candidiasis of the nails and skin.

The compound is included in varnishes, creams Batrafen, Fongial, vaginal cream and suppositories Dafnedzhin. External agents are effective for onychomycosis, skin candidiasis, and dermatophytosis.

Flucytosine

The drug of this group, Ancotil, is used to treat aspergillosis, unaccounted for mycosis, cryptococcosis, and candidal septicemia.

Chloronitrophenol

Nitrofungin solution is used externally to treat mycosis of the feet, inguinal athlete's foot, candidiasis, nail fungus, and dermatophytosis.

Nirtofungin inhibits the growth of colonies of microorganisms, kills fungal cells, and is used in the treatment of mixed infections in case of bacterial infection. Contraindicated during pregnancy and children under 2 years of age.

External means

Modern synthetic antifungal drugs in tablets, solutions for infusions and external use, ointments, creams, and varnishes for local treatment have a wide spectrum of action.

When treating fungus of the nails and feet, in order to ensure access of the antifungal agent to the lesion, the stratum corneum layer of the skin is first detached.

Absorbable (keratolytic) ointments include naftalan, sulfur preparations, ichthyol, salicylic acid mixed with lactic acid, and tar.

Skin and nail fungus is treated with antifungal ointments, creams Travocort, Lotriderm, Triderm, Sikorten plus, Sinalar K, Sangviritrin.

Antifungal varnishes have a deep effect on fabrics. The varnish is a collodion into which anti-fungal medicine is injected. When applied to nails, skin, or the surface, a thin film is formed that has a therapeutic effect. Nail fungus is treated with Loceryl and Batrafen varnishes.

Ointments containing tar, sulfur, undicylenic acid, an alcohol solution of iodine, and aniline dyes have not lost their value in the treatment of fungus.

To treat scalp, use antifungal shampoos Nizoral, Mikozoral, Cynovit, Sebiprox, Mikanisal.

For the treatment of mycoses of the skin of the face, skin folds, scalp, beard, and smooth skin of the body, antifungal ointments Nystatin, Amyclone, and Lamisil are used.

Antifungal ointments, as a rule, have age restrictions and a large list of contraindications; they are not allowed during pregnancy or lactation.

Self-medication with antifungals is dangerous; uncontrolled use of antifungals can cause allergies, dermatitis, and disrupt liver function.

Systemic therapy with antifungal drugs causes fewer side effects while taking vitamins and hepatoprotectors.

Antifungal drugs for children

The delicate skin of newborns, infants, and children under 3 years of age is more susceptible to fungal diseases than the skin of adults. Diaper rash on the skin serves as an entry point for the yeast-like fungus Candida.

For the treatment of children, the antifungal ointment Candid-B is approved, and for damage to the mucous membranes, Pifamucin drops are allowed.

For diaper dermatitis, Nystatin ointment is used, and powders with nystatin are available. When using powders, be careful: the child should not inhale the powder.

Children under one year of age and older are treated for cutaneous candidiasis with Clotrimazole cream or its analogues: Clotrimazole-Acri, Candibene, Imidil, Candizol.

Antifungal ointments with clotrimazole are also used in adults to treat urogenital infections, eliminate itching in the intimate area, and symptoms of infection.

Children over 3-5 years of age more often develop skin diseases of the scalp - microsporia, trichophytosis, known as ringworm, and athlete's foot.

Antifungal drugs for the body, legs, and facial skin with clotrimazole are effective for all types of cutaneous mycosis, are affordable, and are approved for children.

Many plants have antifungal properties.

Black currant, dill, sage, black tea, ginger, peppermint, and lemon exhibit antifungal activity. If the child does not have allergies, weak plant decoctions are used to wipe skin folds and diaper rash on the skin.

Drugs for the treatment of mycoses

Fungal diseases are treated comprehensively, several drugs are prescribed to expand the spectrum of action, and different forms of drugs are used - ointments, creams, tablets, solutions.

Systemic treatment of deep mycoses

• Antifungal antibiotics amphotericin B, mycoheptin.
• Antifungal agents based on miconazole, ketoconazole, itraconazole, fluconazole.

Dermatomycoses

• Antifungal antibiotic griseofulvin.
• Antimycotics with terbinafine, chlornitrophenol (nitrofungin), iodine preparations.

Candidiasis

• Antifungal antibiotics levorin, nystatin, amphotericin B.
• Antifungal agents with miconazole, clotrimazole, dequalinium chloride.

See the ““ section for more details.

Combination treatment using several drugs is necessary for the most complete coverage of all possible pathogens of mycosis.

Thus, new antifungal drugs from the echinocandin group are not active against cryptococci. The effect of echinocandins is enhanced by the administration of amphotericin B, which inhibits the growth of cryptococci.

Positive treatment results are observed when complex therapy is prescribed in patients with immunodeficiency conditions. The combination of antimycotics is selected depending on the type of fungi, aggressiveness, and patient’s condition.

Fungal infection is a common reason for visiting doctors of various specialties. In some cases, it becomes a threat to the patient’s life and requires immediate treatment; in others, mycosis can only cause discomfort and a feeling of embarrassment in front of others. Many oncological and systemic diseases are treated with aggressive drugs that suppress the immune system and cause the proliferation of pathogens, which can only be eliminated by antifungal drugs. Therefore, it is important to promptly recognize the infection and begin its treatment, and in some cases, prevent infection.

Antimycotics are represented by a wide variety of drugs. These are mainly broad-spectrum drugs, many of which are effective not only against pathogenic fungi, but also against other microbes. They are prescribed by a doctor after diagnosis and are taken until the infection is completely cured.

Types of Antifungal Drugs

Antifungal agents are available in the following dosage forms:

• topical products in the form of cream, gel, ointment, spray and drops;
• oral medications in the form of capsules, tablets or syrup;
• solutions for intravenous infusions;
• intravaginal tablets.

Adverse reactions

Antifungal medications may cause side effects. They usually only last for a short period of time. These include:

• itching or burning;
• redness;
• abdominal pain;
• diarrhea;
• skin rash.

Some drugs have more serious side effects. When taking them, a patient may develop anaphylactic shock or Quincke's edema: the face, neck or tongue swell, difficulty breathing may occur, and blisters appear on the skin.

In case of overdose, as well as in patients with liver diseases, liver failure may develop, in which the patient complains of the following symptoms:

Polyenes

This is a group of drugs of natural origin. The main substance is obtained from bacteria of the genus Streptomyces. Upon contact with the fungus, it interacts with ergosterol, which is part of the plasma membrane, as a result of which a channel is formed in the wall, respiration processes are disrupted and the cell dies. Polyene antifungal drugs include:

• Nystatin;
• Amphotericin B;
• Pimafucin.

Nystatin

Antimycotic agent effective against fungi of the genus Candida.

Nystatin is used for local infection, candidiasis of the oral cavity, mucous membranes, skin, and internal organs. It is not used for systemic diseases.

The drug is available in the form of tablets, ointments, and suppositories. It is low-toxic, rarely causes side effects, and is therefore approved for use in children. When taken, the medicine increases sensitivity to ultraviolet rays, so during therapy you should avoid prolonged exposure to the sun. Since the composition contains sugar, the drug is contraindicated in patients with enzyme deficiency of the gastrointestinal tract.

Amphotericin B

A drug with a wide spectrum of activity, which is used to treat both severe fungal systemic diseases and local mycoses.

The medicine can be taken by pregnant women, but with caution; lactation should be stopped during treatment. Cannot be used by patients with kidney and liver damage.

It is used externally as an ointment or intravenously. Administration of the drug intravenously can be accompanied by a considerable number of side effects: from phlebitis (inflammation of the vein) in the area of ​​drug administration to toxic effects on the liver and kidneys.

Azoles

The chemical structure of these products includes two or three nitrogen molecules. Depending on the amount of this element, they are divided into imidazoles and triazoles. Imidazoles include:

• Ketoconazole;
• Miconazole;
• Clotrimazole.

Zalain is a derivative of imidazole and benzothiophene.

Triazoles come in two names:

• Fluconazole;
• Itraconazole

The mechanism of action of drugs in this group is expressed in the inhibition of enzymes dependent on cytochrome P450, which are involved in the biosynthesis of cell membrane sterols. This leads to disruption of the integrity of the fungal cell.

The range of action of drugs in this group is wide, and side effects are less common compared to polyene antibiotics. But long-term use of azoles can cause life-threatening liver failure.

It is more often caused by imidazoles than triazoles. It is not recommended to take azoles with medications such as:

• Cyclosporine;
• antihistamines;
• oral hypoglycemic agents;
• anticoagulant drugs;
• drugs that are metabolized in the liver.

Ketoconazole

A good antifungal drug that is widely used in dermatology. It works effectively when taken in tablet form, but it can also be used topically. Available in the form:

• ointments;
• tablets;
• shampoo.

Active against infections caused by H. capsulatum and B. dermatitidis. The medicine is prescribed for the treatment of:

• thrush;
• dermatomycosis;
• nail fungus;
• ringworm;
• mycosis of the genitourinary organs.

The drug can be used prophylactically to prevent infection.

Fluconazole

It is used for external mycoses and systemic fungal infections. Available in:

• capsules;
• syrup;
• solution for infusion.

One of the main indications for use is candidiasis of various localizations (skin, genital area, oral cavity). The medicine is well tolerated, side effects are rare, including skin rash and diarrhea. It is not recommended for use by children and pregnant women.

Itraconazole

An inexpensive antifungal medicine that is prescribed for mycotic lesions of the skin, mucous membranes, and nail plates.

The drug is presented in the form of capsules for oral administration. It is not recommended to use Itraconazole in patients with diseases of the cardiovascular system, liver and kidney failure. If you are pregnant or breastfeeding, you should not take this medicine. Side effects may include:

• allergic reaction;
• phenomena of dyspepsia;
• headache;
• dizziness.

More severe complications include the possibility of developing heart and liver failure.

Zalain

A modern medicine of a new generation with a wide spectrum of action. It is used to combat external fungus and vaginal candidiasis. Available in the form of ointments and suppositories. Zalain practically does not cause side effects and does not have a systemic effect on the body. It is not recommended for use by pregnant women and women during lactation. The result after starting use is noticeable almost immediately.

Allylamines

This group of antimycotic drugs is represented by two drugs: Terbinafine and Naftifine. They are used for fungal diseases of external localization (onychomycosis, skin fungus).

Terbinafine

Terbinafine effectively fights against pathogenic fungi and has an antibacterial effect.

At the pharmacy, the medicine can be found in the form of tablets, spray, cream and solution for external use. The drug is approved for children over 2 years of age.

Adverse reactions are minimal, patients may complain of:

Naftifin

This antimycotic is used for external use against skin fungus and damage to the nail plates. Contraindicated if you are allergic to the components of the drug. Pregnant women should use it with caution; it is not prescribed to children.

Side effects are predominantly local: rash, itching, burning in the areas of application.

Morpholine derivatives

This group is represented by one drug - Amorolfine. The drug is inexpensive, but effective when used correctly. Available in the form of nail polish, cream and spray. The medicine gives the most reliable results for onychomycosis.

• children (no studies have been conducted on the effect of the drug on the children’s body);
• pregnant and lactating women;
• people with hypersensitivity to the drug.

Undesirable reactions may include skin rashes and itching.

Other antifungal drugs

Based on the test results, the doctor may prescribe antimycotics from other chemical groups.

Griseofulvin

An antifungal medicine that is obtained from the bacterium Penicillium griseofulvum. Available in tablet form. Prescribed for mycoses of the skin, feet, and scalp.

Contraindications for use are:

• systemic diseases;
• kidney and liver damage;
• oncological diseases;
• age up to 2 years;
• pregnancy and lactation.

The drug reduces the effectiveness of hormonal contraceptives and indirect anticoagulants.

Flucytosine

This medicine is an antimetabolite that has fungicidal and fungistatic effects. Its mechanism of action is to inhibit the synthesis of DNA and RNA in the fungal cell.

The medicine is effective for:

• severe systemic diseases;
• fungal meningitis;
• candidiasis;
• cryptococcosis;
• aspergillosis.

Flucytosine is contraindicated:

• during pregnancy;
• during breastfeeding;
• in childhood;
• people with blood diseases and kidney failure.

The drug is used as an infusion for intravenous administration. It can have a large number of side effects, some of which are seriously life-threatening:

• cardiac arrest, respiratory arrest;
• gastrointestinal bleeding;
• liver failure.

Therefore, the medicine is prescribed according to strict indications and its use must be under the supervision of a doctor.

Before using any of the medications, you should read the instructions, and if any unwanted reactions occur, immediately contact your doctor.