Antifungal drugs, or antimycotics, are a rather extensive class of various chemical compounds, both of natural origin and obtained by chemical synthesis, that have specific activity against pathogenic fungi. Depending on the chemical structure, they are divided into several groups that differ in their spectrum of activity, pharmacokinetics and clinical use in various fungal infections (mycoses).

Classification of antifungal drugs

Polyenes:

Nystatin

Natamycin

Amphotericin B

Amphotericin B liposomal

Azoles:

For systemic use

Ketoconazole

Fluconazole

Itraconazole

For topical application

clotrimazole

Miconazole

Bifonazole

Econazole

Isoconazole

Oxyconazole

Allylamines:

For systemic use

For topical application

Preparations of different groups:

For systemic use

Griseofulvin

Potassium iodide

For topical application

Amorolfine

Cyclopirox

The need for the use of antifungal drugs in recent times increased significantly due to an increase in the prevalence of systemic mycoses, including severe life-threatening forms, which is primarily due to an increase in the number of patients with immunosuppression of various origins. More frequent invasive medical procedures and the (often unjustified) use of powerful AMPs are also important. a wide range actions.

Polyena

Polyenes that are natural antimycotics include nystatin, levorin, and natamycin, which are applied topically and orally, as well as amphotericin B, which is used primarily for the treatment of severe systemic mycoses. Liposomal amphotericin B is one of the modern dosage forms of this polyene with improved tolerability. It is obtained by encapsulating amphotericin B in liposomes (fat vesicles formed when phospholipids are dispersed in water), which ensures the release of the active substance only upon contact with fungal cells and is intact with respect to normal tissues.

Mechanism of action

Polyenes, depending on the concentration, can have both fungistatic and fungicidal effects due to the binding of the drug to the ergosterol of the fungal membrane, which leads to a violation of its integrity, loss of cytoplasmic content and cell death.

Activity spectrum

Polyenes have the broadest spectrum of activity among antifungal drugs. in vitro.

When used systemically (amphotericin B), sensitive Candida spp. (among C. lusitaniae resistant strains are found). Aspergillus spp. ( A.terreus may be sustainable) C.neoformans, pathogens of mucomycosis ( Mucor spp., Rhizopus spp. and etc.), S.schenckii, causative agents of endemic mycoses ( B. dermatitidis, H. capsulatum, C.immitis, P. brasiliensis) and some other mushrooms.

However, when applied topically (nystatin, levorin, natamycin), they act mainly on Candida spp.

Polyenes are also active against some protozoa - Trichomonas (natamycin), Leishmania and Amoeba (amphotericin B).

Polyenes are resistant to dermatomycete fungi and pseudo-allescheria ( P. boydii).

Pharmacokinetics

All polyenes are practically not absorbed in the gastrointestinal tract and when applied topically. Amphotericin B when administered intravenously is distributed to many organs and tissues (lungs, liver, kidneys, adrenal glands, muscles, etc.), pleural, peritoneal, synovial and intraocular fluid. Poorly passes through the BBB. Slowly excreted by the kidneys, 40% of the administered dose is excreted within 7 days. The half-life is 24-48 hours, but with prolonged use it can increase up to 2 weeks due to cumulation in tissues. The pharmacokinetics of liposomal amphotericin B is generally less well understood. There is evidence that it creates higher peak blood concentrations than standard. It practically does not penetrate into the tissue of the kidneys (therefore, it is less nephrotoxic). It has more pronounced cumulative properties. The elimination half-life averages 4-6 days, with prolonged use, an increase up to 49 days is possible.

Adverse reactions

Nystatin, levorin, natamycin

(for systemic use)

Allergic reactions: rash, itching, Stevens-Johnson syndrome (rare).

(when applied topically)

Irritation of the skin and mucous membranes, accompanied by a burning sensation.

Amphotericin B

Reactions to IV infusion: fever, chills, nausea, vomiting, headache, hypotension. Preventive measures: premedication with the introduction of NSAIDs (paracetamol, ibuprofen) and antihistamines (diphenhydramine).

Local reactions: pain at the site of infusion, phlebitis, thrombophlebitis. Preventive measures: the introduction of heparin.

Kidneys: dysfunction - decreased diuresis or polyuria. Control measures: monitor clinical analysis of urine, determination of serum creatinine levels every other day during dose increase, and then at least twice a week. Preventive measures: hydration, exclusion of other nephrotoxic drugs.

Liver: possible hepatotoxic effect. Control measures: clinical and laboratory (transaminase activity) monitoring.

Electrolyte imbalances: hypokalemia, hypomagnesemia. Control measures: determination of the concentration of electrolytes in blood serum 2 times a week.

Hematological reactions: most often anemia, less often leukopenia, thrombocytopenia. Control measures: a clinical blood test with the determination of the number of platelets 1 time per week.

GIT: abdominal pain, anorexia, nausea, vomiting, diarrhea.

Nervous system: headache, dizziness, paresis, sensory disturbance, tremor, convulsions.

Allergic reactions: rash, itching, bronchospasm.

Amphotericin B liposomal

Compared to the standard drug, it rarely causes anemia, fever, chills, hypotension, and is less nephrotoxic.

Indications

Nystatin, levorin

Candida vulvovaginitis.

(Prophylactic use is ineffective!)

Natamycin

Candidiasis of the skin, oral cavity and pharynx, intestines.

Candida vulvovaginitis.

Candida balanoposthitis.

Trichomonas vulvovaginitis.

Amphotericin B

Severe forms of systemic mycoses:

invasive candidiasis,

aspergillosis,

cryptococcosis,

sporotrichosis,

mucormycosis,

trichosporosis,

fusarium,

pheogyphomycosis,

endemic mycoses (blastomycosis, coccidioidomycosis, paracoccidioidomycosis, histoplasmosis, penicilliosis).

Candidiasis of the skin and mucous membranes (locally).

Leishmaniasis.

Primary amoebic meningoencephalitis caused by N. fowleri.

Amphotericin B liposomal

Severe forms of systemic mycoses (see amphotericin B) in patients with renal insufficiency, with the ineffectiveness of the standard drug, with its nephrotoxicity, or severe reactions to IV infusion that cannot be stopped by premedication.

Contraindications

For all polyenes

Allergic reactions to drugs of the polyene group.

Additionally for amphotericin B

Liver dysfunction.

Kidney dysfunction.

Diabetes.

All contraindications are relative, since amphotericin B is almost always used for health reasons.

Warnings

Allergy. Data on cross-allergy to all polyenes are not available, however, in patients with an allergy to one of the polyenes, other drugs in this group should be used with caution.

Pregnancy. Amphotericin B passes through the placenta. adequate and strict controlled studies The safety of polyenes in humans has not been evaluated. However, in numerous reports of the use of amphotericin B at all stages of pregnancy, adverse effects on the fetus have not been registered. Recommended to be used with caution.

Lactation. Data on the penetration of polyenes into breast milk are not available. Adverse effects in children on breastfeeding, not marked. Recommended to be used with caution.

Pediatrics. No serious specific problems associated with the appointment of polyenes to children have been registered so far. In the treatment of oral candidiasis in children under 5 years of age, it is preferable to prescribe a suspension of natamycin, since buccal administration of nystatin or levorin tablets may be difficult.

Geriatrics. Due to possible changes in kidney function in the elderly, there may be an increased risk of amphotericin B nephrotoxicity.

Impaired kidney function. The risk of amphotericin B nephrotoxicity is significantly increased, so liposomal amphotericin B is preferred.

Impaired liver function. A higher risk of hepatotoxic action of amphotericin B is possible. It is necessary to compare the possible benefit from the use and the potential risk.

Diabetes. Since amphotericin B solutions (standard and liposomal) for intravenous infusion are prepared in 5% glucose solution, diabetes is a relative contraindication. It is necessary to compare the possible benefits of the application and the potential risk.

Drug Interactions

With the simultaneous use of amphotericin B with myelotoxic drugs (methotrexate, chloramphenicol, etc.), the risk of developing anemia and other hematopoietic disorders increases.

The combination of amphotericin B with nephrotoxic drugs (aminoglycosides, cyclosporine, etc.) increases the risk of severe renal dysfunction.

The combination of amphotericin B with non-potassium-sparing diuretics (thiazide, loop) and glucocorticoids increases the risk of developing hypokalemia, hypomagnesemia.

Amphotericin B, causing hypokalemia and hypomagnesemia, can increase the toxicity of cardiac glycosides.

Amphotericin B (standard and liposomal) is incompatible with 0.9% sodium chloride solution and other solutions containing electrolytes. When using systems for intravenous administration, established for the introduction of other drugs, it is necessary to flush the system with a 5% glucose solution.

Information for patients

When using nystatin, levorin and natamycin, strictly observe the regimen and treatment regimens during the entire course of therapy, do not skip a dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double the dose. Maintain the duration of therapy.

Observe the rules for storing drugs.

Azoles

Azoles are the most representative group of synthetic antimycotics, including drugs for systemic (ketoconazole, fluconazole, itraconazole) and local (bifonazole, isoconazole, clotrimazole, miconazole, oxiconazole, econazole) use. It should be noted that the first of the proposed "systemic" azoles - ketoconazole - after the introduction of itraconazole into clinical practice, has practically lost its significance due to high toxicity and has recently been more often used topically.

Mechanism of action

Azoles have a predominantly fungistatic effect, which is associated with the inhibition of cytochrome P-450-dependent 14α-demethylase, which catalyzes the conversion of lanosterol to ergosterol - the main structural component fungal membrane. Local preparations, when creating high local concentrations in relation to a number of fungi, can act fungicidal.

Activity spectrum

Azoles have a wide spectrum of antifungal activity. The main causative agents of candidiasis are susceptible to itraconazole ( C. albicans, C. parapsilosis, C.tropicalis, C.lusitaniae and etc.), Aspergillus spp., Fusarium spp., C.neoformans, dermatomycetes ( Epidermophyton spp., Trichophyton spp., microsporum spp.), S. schenckii, P.boydii, H. capsulatum, B. dermatitidis, C.immitis, P. brasiliensis and some other mushrooms. Resistance is common in C.glabrata and C. krusei.

Ketoconazole is similar in spectrum to itraconazole, but does not affect Aspergillus spp.

Fluconazole is most active against most pathogens of candidiasis ( C. albicans, C. parapsilosis, C.tropicalis, C. lusitaniae etc.), cryptococcus and coccidioides, as well as dermatomycetes. Blastomycetes, histoplasmas, paracoccidioides and sporotrix are somewhat less sensitive to it. Does not work on aspergillus.

Azoles used topically are active mainly against Candida spp., dermatomycetes, M.furfur. They act on a number of other fungi that cause superficial mycoses. Some gram-positive cocci and corynebacteria are also sensitive to them. Clotrimazole is moderately active against some anaerobes (bacteroids, G.vaginalis) and Trichomonas.

Pharmacokinetics

Ketoconazole, fluconazole and itraconazole are well absorbed from the gastrointestinal tract. At the same time, for the absorption of ketoconazole and itraconazole, a sufficient level of acidity in the stomach is necessary, since, reacting with hydrochloric acid, they turn into highly soluble hydrochlorides. The bioavailability of itraconazole, administered in the form of capsules, is higher when taken with food, and in the form of a solution - on an empty stomach. Peak blood concentrations of fluconazole are reached after 1-2 hours, ketoconazole and itraconazole - after 2-4 hours.

Fluconazole is characterized by a low degree of plasma protein binding (11%), while ketoconazole and itraconazole are almost 99% protein bound.

Fluconazole and ketoconazole are relatively evenly distributed in the body, creating high concentrations in various organs, tissues and secretions. Fluconazole penetrates the BBB and the blood-brain barrier. CSF levels of fluconazole in patients with fungal meningitis range from 52% to 85% of plasma concentrations. Ketoconazole does not pass well through the BBB and creates very low concentrations in the CSF.

Itraconazole, being highly lipophilic, is distributed mainly to organs and tissues with a high fat content: liver, kidneys, and greater omentum. Able to accumulate in tissues that are particularly prone to fungal infection, such as the skin (including the epidermis), nail plates, lung tissue, genitalia, where its concentration is almost 7 times higher than in plasma. In inflammatory exudates, itraconazole levels are 3.5 times higher than plasma levels. At the same time, itraconazole practically does not penetrate into “aquatic” media - saliva, intraocular fluid, CSF.

Ketoconazole and itraconazole are metabolized in the liver, excreted mainly by the gastrointestinal tract. Itraconazole is partially excreted with the secretion of the sebaceous and sweat glands of the skin. Fluconazole is only partially metabolized, excreted by the kidneys mainly unchanged. The half-life of ketoconazole is 6-10 hours, itraconazole is 20-45 hours, does not change with renal failure. The half-life of fluconazole is 30 hours, with renal failure it can increase up to 3-4 days.

Itraconazole is not removed from the body during hemodialysis, the concentration of fluconazole in plasma during this procedure is reduced by 2 times.

Azoles for topical application create high and fairly stable concentrations in the epidermis and underlying affected skin layers, and the concentrations created exceed the MICs for the main fungi that cause skin mycoses. The longest lasting concentrations are characteristic of bifonazole, the half-life of which from the skin is 19-32 hours (depending on its density). Systemic absorption through the skin is minimal and has no clinical significance. With intravaginal application, absorption can be 3-10%.

Adverse reactions

Common to all systemic azoles

Gastrointestinal: abdominal pain, loss of appetite, nausea, vomiting, diarrhea, constipation.

CNS: headache, dizziness, drowsiness, visual disturbances, paresthesia, tremor, convulsions.

Allergic reactions: rash, itching, exfoliative dermatitis, Stevens-Johnson syndrome (more often when using fluconazole).

Hematological reactions: thrombocytopenia, agranulocytosis.

Liver: increased activity of transaminases, cholestatic jaundice.

Additionally for itraconazole

Cardiovascular system: congestive heart failure, arterial hypertension.

Liver: hepatotoxic reactions (rare)

Metabolic disorders: hypokalemia, edema.

Endocrine system: impaired production of corticosteroids.

Additionally for ketoconazole

Liver: severe hepatotoxic reactions, up to the development of hepatitis.

Endocrine system: impaired production of testosterone and corticosteroids, accompanied in men by gynecomastia, oligospermia, impotence, in women - a violation menstrual cycle.

Common to local azoles

With intravaginal use: itching, burning, hyperemia and swelling of the mucous membrane, vaginal discharge, increased urination, pain during intercourse, burning sensation in the penis of the sexual partner.

Indications

Itraconazole

Pityriasis versicolor.

Candidiasis of the esophagus, skin and mucous membranes, nails, candidal paronychia, vulvovaginitis.

Cryptococcosis.

Aspergillosis (with resistance or poor tolerance to amphotericin B).

Pseudoallescheriosis.

Feogyphomycosis.

Chromomycosis.

Sporotrichosis.

endemic mycoses.

Prevention of mycoses in AIDS.

Fluconazole

invasive candidiasis.

Candidiasis of the skin, mucous membranes, esophagus, candidal paronychia, onychomycosis, vulvovaginitis.

Cryptococcosis.

Dermatomycosis: epidermophytosis, trichophytosis, microsporia.

Pityriasis versicolor.

Sporotrichosis.

Pseudoallescheriosis.

Trichosporosis.

Some endemic mycoses.

Ketoconazole

Candidiasis of the skin, esophagus, candidal paronychia, vulvovaginitis.

Pityriasis versicolor (systemically and locally).

Dermatomycosis (locally).

Seborrheic eczema (locally).

Paracoccidioidomycosis.

Azoles for topical use

Candidiasis of the skin, oral cavity and pharynx, vulvovaginal candidiasis.

Dermatomycosis: trichophytosis and epidermophytosis of smooth skin, hands and feet with limited lesions. With onychomycosis, they are ineffective.

Pityriasis versicolor.

Erythrasma.

Contraindications

Allergic reaction to drugs of the azole group.

Pregnancy (systemically).

Breastfeeding (systemically).

Severe liver dysfunction (ketoconazole, itraconazole).

Age up to 16 years (itraconazole).

Warnings

Allergy. Data on cross-allergy to all azoles are not available, however, in patients with an allergy to one of the azoles, other drugs in this group should be used with caution.

Pregnancy. Adequate studies of the safety of azoles in humans have not been conducted. Ketoconazole passes through the placenta. Fluconazole may interfere with estrogen synthesis. There is evidence of teratogenic and embryotoxic effects of azoles in animals. Systemic use in pregnant women is not recommended. Intravaginal use is not recommended in the first trimester, in others - no more than 7 days. For outdoor use, care should be taken.

Lactation. Azoles penetrate into breast milk, and fluconazole creates the highest concentrations in it, close to the level in blood plasma. The systemic use of azoles during breastfeeding is not recommended.

Pediatrics. Adequate safety studies of itraconazole in children under 16 years of age have not been conducted, so it is not recommended for use in this age group. In children, the risk of ketoconazole hepatotoxicity is higher than in adults.

Geriatrics. In the elderly, due to age-related changes in renal function, fluconazole excretion may be impaired, as a result of which a correction of the dosing regimen may be required.

H dysfunction of the kidneys. In patients with renal insufficiency, fluconazole excretion is impaired, which may be accompanied by its cumulation and toxic effects. Therefore, in case of renal insufficiency, a correction of the dosing regimen of fluconazole is required. Periodic monitoring of creatinine clearance is required.

Impaired liver function. Due to the fact that itraconazole and ketoconazole are metabolized in the liver, in patients with a violation of its function, their cumulation and the development of hepatotoxic effects are possible. Therefore, ketoconazole and itraconazole are contraindicated in such patients. When using these antimycotics, it is necessary to conduct regular clinical and laboratory monitoring (transaminase activity monthly), especially when ketoconazole is prescribed. Strict monitoring of liver function is also necessary in people suffering from alcoholism, or receiving other drugs that can adversely affect the liver.

Heart failure. Itraconazole may contribute to the progression of heart failure, so it should not be used for the treatment of skin fungal infections and onychomycosis in patients with impaired cardiac function.

Hypokalemia. When prescribing itraconazole, cases of hypokalemia, which was associated with the development of ventricular arrhythmias, are described. Therefore, with its long-term use, monitoring of the electrolyte balance is necessary.

Drug Interactions

Antacids, sucralfate, anticholinergics, H2-blockers and inhibitors proton pump reduce the bioavailability of ketoconazole and itraconazole, as they lower the acidity in the stomach and disrupt the conversion of azoles into soluble forms.

Didanosine (containing a buffer medium necessary to increase gastric pH and improve drug absorption) also reduces the bioavailability of ketoconazole and itraconazole.

Ketoconazole, itraconazole and, to a lesser extent, fluconazole are inhibitors of cytochrome P-450, therefore, they can interfere with the metabolism of the following drugs in the liver:

oral antidiabetic (chlorpropamide, glipizide, etc.), the result may be hypoglycemia. Strict control of blood glucose is required, with possible adjustment of the dosage of antidiabetic drugs;

indirect anticoagulants of the coumarin group (warfarin, etc.), which may be accompanied by hypocoagulation and bleeding. Laboratory monitoring of hemostasis parameters is required;

cyclosporine, digoxin (ketoconazole and itraconazole), theophylline (fluconazole), which can lead to an increase in their concentration in the blood and toxic effects. Clinical control, monitoring of drug concentrations with possible correction of their dosage is necessary. There are recommendations to reduce the dose of cyclosporine by 2 times since the concomitant appointment of itraconazole;

terfenadine, astemizole, cisapride, quinidine, pimozide. An increase in their concentration in the blood may be accompanied by a prolongation of the QT interval on the ECG with the development of severe, potentially fatal ventricular arrhythmias. Therefore, combinations of azoles with these drugs are unacceptable.

The combination of itraconazole with lovastatin or simvastatin is accompanied by an increase in their concentration in the blood and the development of rhabdomyolysis. During treatment with itraconazole, statins should be discontinued.

Rifampicin and isoniazid increase the metabolism of azoles in the liver and lower their plasma concentrations, which may be the cause of treatment failure. Therefore, azoles are not recommended for use in combination with rifampicin or isoniazid.

Carbamazepine reduces the concentration of itraconazole in the blood, which may be the reason for the ineffectiveness of the latter.

Cytochrome P-450 inhibitors (cimetidine, erythromycin, clarithromycin, etc.) can block the metabolism of ketoconazole and itraconazole and increase their blood concentrations. The simultaneous use of erythromycin and itraconazole is not recommended due to the possible development of cardiotoxicity of the latter.

Ketoconazole interferes with alcohol metabolism and can cause disulfirap-like reactions.

Information for patients

Azole preparations, when taken orally, should be washed down with a sufficient amount of water. Ketoconazole and itraconazole capsules should be taken with or immediately after a meal. With low acidity in the stomach, these drugs are recommended to be taken with drinks that have an acidic reaction (for example, cola). It is necessary to observe intervals of at least 2 hours between taking these azoles and drugs that lower acidity (antacids, sucralfate, anticholinergics, H 2 blockers, proton pump inhibitors).

During treatment with systemic azoles, terfenadine, astemizole, cisapride, pimozide, quinidine should not be taken. In the treatment of itraconazole - lovastatin and simvastatin.

Strictly observe the regimen and treatment regimens during the entire course of therapy, do not skip the dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double the dose. Maintain the duration of therapy.

Do not use drugs that have expired.

Do not use azoles systemically during pregnancy and lactation. Intravaginal use of azoles is contraindicated in the first trimester of pregnancy, in others - no more than 7 days. When treating with systemic azoles, reliable methods of contraception should be used.

Before starting the intravaginal use of azoles, carefully study the instructions for use of the drug. During pregnancy, discuss with your doctor the possibility of using the applicator. Use only special swabs. Observe the rules of personal hygiene. It should be borne in mind that some intravaginal forms may contain ingredients that damage the latex. Therefore, you should refrain from using latex barrier contraceptives during treatment and for 3 days after its completion.

In the treatment of mycoses of the feet, it is necessary to carry out antifungal treatment of shoes, socks and stockings.

Allylamines

Allylamines, which are synthetic antimycotics, include terbinafine, applied orally and topically, and naftifine, intended for topical use. The main indications for the use of allylamines are dermatomycosis.

Mechanism of action

Allylamines have a predominantly fungicidal effect associated with a violation of the synthesis of ergosterol. Unlike azoles, allylamines block earlier stages of biosynthesis by inhibiting the enzyme squalene epoxidase.

Activity spectrum

Allylamines have a wide spectrum of antifungal activity. Dermatomycetes are sensitive to them ( Epidermophyton spp., Trichophyton spp., micro-sporum spp.), M.furfur, candida, aspergillus, histoplasma, blastomycetes, cryptococcus, sporotrix, causative agents of chromomycosis.

Terbinafine active in vitro also against a number of protozoa (some varieties of leishmania and trypanosomes).

Despite the wide spectrum of activity of allylamines, clinical significance has only their effect on causative agents of dermatomycosis.

Pharmacokinetics

Terbinafine is well absorbed from the gastrointestinal tract, and bioavailability is practically independent of food intake. Almost completely (99%) binds to plasma proteins. Having a high lipophilicity, terbinafine is distributed into many tissues. Diffusing through the skin, as well as standing out with the secrets of the sebaceous and sweat glands, it creates high concentrations in the stratum corneum of the epidermis, nail plates, hair follicles, and hair. Metabolized in the liver, excreted by the kidneys. The half-life is 11-17 hours, increases with renal and hepatic insufficiency.

When applied topically, systemic absorption of terbinafine is less than 5%, of naftifine - 4-6%. The preparations create high concentrations in various layers of the skin, exceeding the MIC for the main pathogens of dermatomycosis. The absorbed portion of naftifine is partially metabolized in the liver, excreted in the urine and feces. The half-life is 2-3 days.

Adverse reactions

Terbinafine inside

Gastrointestinal: abdominal pain, loss of appetite, nausea, vomiting, diarrhea, changes and loss of taste.

CNS: headache, dizziness.

Allergic reactions: rash, urticaria, exfoliative dermatitis, Stevens-Johnson syndrome.

Hematological reactions: neutropenia, pancytopenia.

Liver: increased activity of transaminases, cholestatic jaundice, liver failure.

Other: arthralgia, myalgia.

Terbinafine topically, naftifine

Skin: itching, burning, hyperemia, dryness.

Indications

Dermatomycosis: epidermophytosis, trichophytosis, microsporia (with limited damage - locally, with widespread - inside).

Mycosis of the scalp (inside).

Onychomycosis (inside).

Chromomycosis (inside).

Skin candidiasis (locally).

Pityriasis versicolor (locally).

Contraindications

Allergic reaction to drugs of the allylamine group.

Pregnancy.

Lactation.

Age up to 2 years.

Warnings

Allergy. Data on cross-allergy to terbinafine and naftifine are not available, however, in patients with an allergy to one of the drugs, the other should be used with caution.

Pregnancy. Adequate safety studies of allylamines have not been conducted. Use in pregnant women is not recommended.

Lactation. Terbinafine passes into breast milk. Use in breastfeeding women is not recommended.

Pediatrics. Adequate safety studies in children under 2 years of age have not been conducted, so use in this age group is not recommended.

Geriatrics. In the elderly, due to age-related changes in renal function, terbinafine excretion may be impaired, as a result of which a correction of the dosing regimen may be required.

Impaired kidney function. In patients with renal insufficiency, the excretion of terbinafine is impaired, which may be accompanied by its cumulation and toxic effects. Therefore, in case of renal insufficiency, a correction of the dosing regimen of terbinafine is required. Periodic monitoring of creatinine clearance is necessary.

Impaired liver function. Possible increased risk of terbinafine hepatotoxicity. Adequate clinical and laboratory monitoring is required. With the development of severe liver dysfunction during treatment with terbinafine, the drug should be discontinued. Strict monitoring of liver function is necessary in alcoholism and in people receiving other drugs that can adversely affect the liver.

Drug Interactions

Inducers of microsomal liver enzymes (rifampicin, etc.) can increase the metabolism of terbinafine and increase its clearance.

Inhibitors of microsomal liver enzymes (cimetidine, etc.) can block the metabolism of terbinafine and reduce its clearance.

In the situations described, it may be necessary to adjust the dosing regimen of terbinafine.

Information for patients

Terbinafine can be taken orally regardless of food intake (on an empty stomach or after a meal), should be washed down with a sufficient amount of water.

Do not drink alcoholic beverages during treatment.

Do not use drugs that have expired.

Do not use allylamines during pregnancy and lactation.

Do not allow topical preparations to come into contact with the mucous membrane of the eyes, nose, mouth, open wounds.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Preparations of different groups

Griseofulvin

One of the earliest natural antimycotics with a narrow spectrum of activity. It is produced by a fungus of the genus Penicillium. It is used only for dermatomycosis caused by dermatomycete fungi.

Mechanism of action

It has a fungistatic effect, which is due to the inhibition of the mitotic activity of fungal cells in the metaphase and the disruption of DNA synthesis. Selectively accumulating in the "prokeratin" cells of the skin, hair, nails, griseofulvin gives the newly formed keratin resistance to fungal infection. The cure occurs after the complete replacement of the infected keratin, so the clinical effect develops slowly.

Activity spectrum

Dermatomycetes are sensitive to griseofulvin ( Epidermophyton spp., Trichophyton spp., microsporum spp.). Other mushrooms are resistant.

Pharmacokinetics

Griseofulvin is well absorbed from the gastrointestinal tract. Bioavailability is increased when taken with fatty foods. The maximum concentration in the blood is noted after 4 hours. High concentrations are created in the keratin layers of the skin, hair, nails. Only a small part of griseofulvin is distributed to other tissues and secretions. Metabolized in the liver. Excreted with feces (36% in active form) and urine (less than 1%). The half-life is 15-20 hours, does not change with renal failure.

Adverse reactions

Gastrointestinal: abdominal pain, nausea, vomiting, diarrhea.

Nervous system: headache, dizziness, insomnia, peripheral neuritis.

Skin: rash, itching, photodermatitis.

Hematological reactions: granulocytopenia, leukopenia.

Liver: increased activity of transaminases, jaundice, hepatitis.

Other: oral candidiasis, lupus-like syndrome.

Indications

Dermatomycosis: epidermophytosis, trichophytosis, microsporia.

Mycosis of the scalp.

Onychomycosis.

Contraindications

Allergic reaction to griseofulvin.

Pregnancy.

Liver dysfunction.

Systemic lupus erythematosus.

Porfiry.

Warnings

Pregnancy. Griseofulvin crosses the placenta. Adequate safety studies in humans have not been conducted. There is evidence of teratogenic and embryotoxic effects in animals. Use in pregnant women is not recommended.

Lactation.

Geriatrics. In the elderly, due to age-related changes in liver function, the risk of hepatotoxicity of griseofulvin may be increased. Strict clinical and laboratory control is required.

Impaired liver function. Due to the hepatotoxicity of griseofulvin, its administration requires regular clinical and laboratory monitoring. In case of impaired liver function, it is not recommended to prescribe. Strict monitoring of liver function is also necessary in alcoholism and in people receiving other drugs that can adversely affect the liver.

Drug Interactions

Inducers of microsomal liver enzymes (barbiturates, rifampicin, etc.) can increase the metabolism of griseofulvin and weaken its effect.

Griseofulvin induces cytochrome P-450, therefore, it can increase metabolism in the liver and, therefore, weaken the effect of:

indirect anticoagulants of the coumarin group (control of prothrombin time is necessary, dose adjustment of the anticoagulant may be required);

oral antidiabetic drugs, (blood glucose control with possible dose adjustment of antidiabetic drugs);

theophylline (monitoring of its concentration in the blood with possible dose adjustment);

Griseofulvin enhances the effect of alcohol.

Information for patients

Griseofulvin should be taken orally during or immediately after a meal. If a low-fat diet is being used, griseofulvin should be taken with 1 tablespoon vegetable oil.

Do not drink alcoholic beverages during treatment.

Strictly observe the regimen and treatment regimens during the entire course of therapy, do not skip the dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double the dose.

Do not use drugs that have expired.

Be careful with dizziness.

Do not expose to direct insolation.

Do not use griseofulvin during pregnancy and lactation.

During treatment with griseofulvin and within 1 month after the end, do not use only estrogen-containing oral preparations for contraception. Be sure to use additional or alternative methods.

In the treatment of mycoses of the feet, it is necessary to carry out antifungal treatment of shoes, socks and stockings.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Potassium iodide

As an antifungal drug, potassium iodide is used orally as a concentrated solution (1.0 g/ml). The mechanism of action is not exactly known.

Activity spectrum

Active against many fungi, but the main clinical significance is the effect on S.schenckii.

Pharmacokinetics

Quickly and almost completely absorbed in the gastrointestinal tract. It is distributed mainly in the thyroid gland. It also accumulates in the salivary glands, gastric mucosa, and mammary glands. Concentrations in saliva, gastric juice and breast milk are 30 times higher than in blood plasma. Excreted mainly by the kidneys.

Adverse reactions

Gastrointestinal: abdominal pain, nausea, vomiting, diarrhea.

Endocrine system: changes in thyroid function (requires appropriate clinical and laboratory monitoring).

Reactions of iodism: rash, rhinitis, conjunctivitis, stomatitis, laryngitis, bronchitis.

Others: lymphadenopathy, swelling of the submandibular salivary glands.

With the development of severe HP should reduce the dose or temporarily stop taking. After 1-2 weeks, treatment can be resumed at lower doses.

Indications

Sporotrichosis: cutaneous, cutaneous-lymphatic.

Contraindications

Hypersensitivity to iodine preparations.

Hyperthyroidism.

Tumors of the thyroid gland.

Warnings

Pregnancy. Adequate safety studies have not been conducted. Use in pregnant women is possible only in cases where the intended benefit outweighs the risk.

Lactation. Concentrations of potassium iodide in breast milk are 30 times higher than in plasma. During treatment, breastfeeding should be discontinued.

Drug Interactions

When combined with potassium preparations or potassium-sparing diuretics, hyperkalemia may develop.

Information for patients

Potassium iodide should be taken orally after meals. A single dose is recommended to be diluted with water, milk or fruit juice.

Strictly observe the regimen and treatment regimens during the entire course of therapy, do not skip the dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double the dose. Maintain the duration of therapy. Irregular use or premature termination of treatment increases the risk of relapse.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Amorolfine

Synthetic antimycotic agent for topical use (in the form of nail polish), which is a derivative of morpholine.

Mechanism of action

Depending on the concentration, it can have both fungistatic and fungicidal effects due to a violation of the structure of the cell membrane of fungi.

Activity spectrum

It is characterized by a wide spectrum of antifungal activity. sensitive to him Candida spp., dermatomycetes, Pityrosporum spp., Cryptococcus spp. and a number of other mushrooms.

Pharmacokinetics

When applied topically, it penetrates well into the nail plate and nail bed. Systemic absorption is insignificant and has no clinical significance.

Adverse reactions

Local: burning, itching or irritation of the skin around the nail, discoloration of the nails (rarely).

Indications

Onychomycosis caused by dermatomycetes, yeasts and molds (if no more than 2/3 of the nail plate is affected).

Prevention of onychomycosis.

Contraindications

Hypersensitivity to amorolfine.

Pregnancy.

Lactation.

Age up to 6 years.

Warnings

Pregnancy.

Lactation. Adequate safety data are not available. Use during breastfeeding is not recommended.

Pediatrics.

Drug Interactions

Systemic antimycotics enhance the therapeutic effect of amorolfine.

Information for patients

Carefully study the instructions for use.

Maintain the duration of therapy. Irregular use or premature termination of treatment increases the risk of relapse.

All altered nail tissue should be regularly ground down. Files used on diseased nails should not be used on healthy nails.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Observe storage rules.

Cyclopirox

Synthetic antifungal drug for topical use with a wide spectrum of activity. The mechanism of action has not been established.

Activity spectrum

sensitive to ciclopirox Candida spp., dermatomycetes, M.furfur, Cladosporium spp. and many other mushrooms. It also acts on some gram-positive and gram-negative bacteria, mycoplasmas and Trichomonas, but this is of no practical importance.

Pharmacokinetics

When applied topically, it quickly penetrates into various layers of the skin and its appendages, creating high local concentrations that are 20–30 times higher than the MIC for the main pathogens of superficial mycoses. When applied to large areas, it can be slightly absorbed (1.3% of the dose is found in the blood), 94–97% binds to plasma proteins, and is excreted by the kidneys. The half-life is 1.7 hours.

Adverse reactions

Local: burning, itching, irritation, peeling or flushing of the skin.

Indications

Dermatomycosis caused by dermatomycetes, yeasts and molds.

Onychomycosis (if no more than 2/3 of the nail plate is affected).

Fungal vaginitis and vulvovaginitis.

Prevention of fungal infections of the feet (powder in socks and / or shoes).

Contraindications

Hypersensitivity to ciclopirox.

Pregnancy.

Lactation.

Age up to 6 years.

Warnings

Pregnancy. Adequate safety studies have not been conducted. Use in pregnant women is not recommended.

Lactation. Adequate safety data are not available. Use during breastfeeding is not recommended.

Pediatrics. Adequate safety studies have not been conducted. Use in children under 6 years of age is not recommended.

Drug Interactions

Systemic antimycotics enhance the therapeutic effect of ciclopirox.

Information for patients

Carefully study the instructions for use of the prescribed dosage form of the drug.

Strictly observe the regimen and treatment regimens during the entire course of therapy.

Maintain the duration of therapy. Irregular use or premature termination of treatment increases the risk of relapse.

Protective impervious gloves must be worn when working with organic solvents.

In the treatment of onychomycosis, all altered nail tissue should be regularly ground down. Files used on affected nails should not be used on healthy nails.

Avoid getting the solution and cream in the eyes.

The vaginal cream must be inserted deep into the vagina using the supplied disposable applicators, preferably at night. A new applicator is used for each procedure.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Observe storage rules.

Table. Antifungal drugs.
Main characteristics and application features

INN	Lekform LS	F (inside), %	T ½, h *	Dosing regimen	Features of drugs
Polyena
Amphotericin B	Since. d/inf. 0.05 g in vial. Ointment 3% in tubes of 15 g and 30 g	-	24–48	I/V Adults and children: test dose of 1 mg in 20 ml of 5% glucose solution for 1 hour; therapeutic dose 0.3–1.5 mg/kg/day Rules for the introduction of a therapeutic dose: diluted in 400 ml of 5% glucose solution, administered at a rate of 0.2–0.4 mg / kg / h locally The ointment is applied to the affected areas of the skin 1-2 times a day.	It has a wide spectrum of antifungal activity, but is highly toxic. It is used in/in with severe systemic mycoses. The duration of treatment depends on the type of mycosis. To prevent infusion reactions, premedication is carried out using NSAIDs and antihistamines. Enter only on glucose! Topically used for candidiasis of the skin
Amphotericin B liposomal	Since. d/inf. 0.05 g in vial.	-	4–6 days	I/V Adults and children: 1–5 mg/kg/day	It is better tolerated than amphotericin B. It is used in patients with renal insufficiency, with the ineffectiveness of the standard drug, its nephrotoxicity, or infusion reactions that cannot be stopped by premedication. Enter only on glucose!
Nystatin	Tab. 250 thousand units and 500 thousand units Tab. vagina. 100 thousand units Ointment 100 thousand units / g	-	ND	inside Adults: 500,000–1 million units every 6 hours for 7–14 days; with candidiasis of the oral cavity and pharynx, dissolve in 1 table. every 6-8 hours after meals Children: 125-250 thousand units every 6 hours for 7-14 days intravaginally 1-2 tables. vagina. overnight for 7-14 days locally	Only works on mushrooms Candida Practically not absorbed in the gastrointestinal tract, acts only with local contact Indications: candidiasis of the skin, oral cavity and pharynx, intestines, vulvovaginal candidiasis
Levorin	Tab. 500 thousand units Tab. slap 500 thousand units Tab. vagina. 250 thousand units Ointment 500 thousand units / g	-	ND	inside Adults: 500 thousand units every 8 hours for 7-14 days; with candidiasis of the oral cavity and pharynx, dissolve in 1 table. slap every 8-12 hours after meals Children: up to 6 years - 20-25 thousand units / kg every 8-12 hours for 7-14 days; older than 6 years - 250 thousand units every 8-12 hours for 7-14 days intravaginally 1-2 tables. overnight for 7-14 days locally The ointment is applied to the affected areas of the skin 2 times a day.	Similar in action and application to nystatin
Natamycin	Tab. 0.1 g Susp. 2.5% in vial. 20 ml Vagina candles. 0.1 g Cream 2% in tubes of 30 g	-	ND	inside Adults: 0.1 g every 6 hours for 7 days Children: 0.1 g every 12 hours for 7 days With candidiasis of the oral cavity and pharynx, adults and children are applied to the affected areas with 0.5–1 ml of susp. every 4-6 hours intravaginally 1 suppository at night for 3-6 days locally The cream is applied to the affected areas of the skin 1-3 times a day.	Compared with nystatin and levorin, it has a slightly wider spectrum of activity. Similar indications
Azoles
Itraconazole	Caps. 0.1 g Solution for oral administration 10 mg / ml in a vial. 150 ml	Caps. 40-55 (on an empty stomach) 90-100 (with food) Solution 90-100 (on an empty stomach) 55 (with food)	20–45	inside Adults: 0.1-0.6 g every 12-24 hours, the dose and duration of the course depends on the type of infection; with vulvovaginal candidiasis - 0.2 g every 12 hours one day or 0.2 g / day for 3 days	It has a wide spectrum of activity and fairly good tolerance. Indications: aspergillosis, sporotrichosis, candidiasis of the esophagus, skin and its appendages, mucous membranes, vulvovaginal candidiasis, ringworm, pityriasis versicolor. Interacts with many drugs. Caps. should be taken during or immediately after a meal, rr - 1 hour or 2 hours after a meal
Fluconazole	Caps. 0.05 g, 0.1 g, 0.15 g Since. for susp. d / ingestion of 10 mg / ml and 40 mg / ml in a vial. 50 ml Solution for inf. 2 mg/ml in vial. 50 ml	90	30	inside Adults: 0.1-0.6 g / day in 1 dose, the duration of the course depends on the type of infection; with sporotrichosis and pseudoalescheriasis - up to 0.8–0.12 g / day; with candidal onychomycosis and paronychia - 0.15 g once a week; with pityriasis versicolor - 0.4 g once; with vulvovaginal candidiasis 0.15 g once Children: with candidiasis of the skin and mucous membranes - 1-2 mg / kg / day in 1 dose; with systemic candidiasis and cryptococcosis - 6-12 mg / kg / day in 1 dose I/V Adults: 0.1-0.6 g / day in 1 injection; with sporotrichosis and pseudoalescheriosis - up to 0.8–0.12 g / day Children: with candidiasis of the skin and mucous membranes - 1-2 mg / kg / day in 1 injection; with systemic candidiasis and cryptococcosis - 6-12 mg / kg / day in 1 injection In / in administered by slow infusion at a rate of not more than 10 ml / min	Most active in relation to candida spp., cryptococcus, dermatomycetes. The drug of choice for the treatment of candidiasis. It penetrates well through the BBB, high concentration in the CSF and urine. Very well tolerated. Inhibits cytochrome P-450 (weaker than itraconazole)
Ketoconazole	Tab. 0.2 g Cream 2% in tubes of 15 g Shampoo. 2% in vial. 25 ml and 60 ml each	75	6–10	inside Adults: 0.2-0.4 g / day in 2 doses, the duration of the course depends on the type of infection. locally The cream is applied to the affected areas of the skin 1-2 times a day for 2-4 weeks. Shampoo. used for seborrheic eczema and dandruff - 2 times a week for 3-4 weeks, for pityriasis versicolor - daily for 5 days (applied to the affected areas for 3-5 minutes, then washed off with water)	Apply inside or topically. Does not penetrate the BBB. It has a wide spectrum of activity, but systemic use is limited due to hepatotoxicity. Can cause hormonal disorders, interacts with many drugs. Locally used for pityriasis versicolor, ringworm, seborrheic eczema. Inside should be taken during or immediately after a meal
clotrimazole	Tab. vagina. 0.1 g Cream 1% in tubes of 20 g	3–10 **	ND	intravaginally Adults: 0.1 g at night for 7–14 days locally Cream and solution are applied to the affected areas of the skin with light rubbing 2-3 times a day. With candidiasis of the oral cavity and pharynx - treat the affected areas with 1 ml r-ra 4 times a day	Basic imidazole for topical use. Indications: candidiasis of the skin, oral cavity and pharynx, vulvovaginal candidiasis, ringworm, pityriasis versicolor, erythrasma
Bifonazole	Cream 1% in tubes of 15 g, 20 g and 35 g Cream 1% in the set for the treatment of nails Solution for nar. 1% in vial. 15 ml	2–4 ***	ND	locally The cream and solution are applied to the affected areas of the skin with light rubbing once a day (preferably at night). In case of onychomycosis, after applying the cream, close the nails with a plaster and a bandage for 24 hours, after removing the bandage, dip the fingers in warm water for 10 minutes, then remove the softened nail tissue with a scraper, dry the nail and reapply the cream and apply the patch. The procedures are carried out for 7-14 days (until the nail bed becomes smooth and the entire affected part is removed)	Indications: skin candidiasis, ringworm, onychomycosis (with limited lesions), pityriasis versicolor, erythrasma
Econazole	Cream 1% in tubes of 10 g and 30 g Aeroz. 1% in vial. 50 g each Vagina candles. 0.15 g	-	ND	locally The cream is applied to the affected areas of the skin and gently rubbed, 2 times a day. Aeroz. spray from a distance of 10 cm on the affected areas of the skin and rub until completely absorbed, 2 times a day intravaginally
Isoconazole	Vagina candles. 0.6 g	-	ND	locally The cream is applied to the affected areas of the skin 1 time per day for 4 weeks. intravaginally 1 suppository at night for 3 days	Indications: skin candidiasis, vulvovaginal candidiasis, ringworm
Oxyconazole	Cream 1% in tubes of 30 g	-	ND	locally The cream is applied to the affected areas of the skin 1 time per day for 2-4 weeks.	Indications: skin candidiasis, ringworm
Allylamines
Terbinafine	Tab. 0.125 g and 0.25 g Cream 1% in tubes of 15 g Spray 1% in a bottle. 30 ml	80 (inside) less than 5 (locally)	11–17	inside Adults: 0.25 g/day in 1 dose Children over 2 years old: body weight up to 20 kg - 62.5 mg / day, 20-40 kg - 0.125 g / day, more than 40 kg - 0.25 g / day, in 1 dose The duration of the course depends on the location of the lesion. locally Cream or spray is applied to the affected areas of the skin 1-2 times a day for 1-2 weeks.	Indications: ringworm, mycosis of the scalp, onychomycosis, chromomycosis, skin candidiasis, pityriasis versicolor
Naftifin	Cream 1% in tubes of 1 g and 30 g Solution 1% in a bottle. 10 ml	4–6 (local)	2–3 days	locally Cream or solution is applied to the affected areas of the skin 1 time per day for 2-8 weeks	Indications: skin candidiasis, ringworm, pityriasis versicolor
Drugs of other groups
Griseofulvin	Tab. 0.125 g and 0.5 g Susp. d / ingestion 125 mg / 5 ml in a vial.	70–90	15–20	inside Adults: 0.25–0.5 g every 12 hours Children: 10 mg/kg/day in 1-2 doses	One of the oldest antimycotics for systemic use. Reserve drug for dermatomycosis. In severe lesions, it is inferior in effectiveness to systemic azoles and terbinafine. Induces cytochrome P-450. Enhances the effects of alcohol
Potassium iodide	Since. (used as a solution of 1 g/ml)	90–95	ND	inside Adults and children: the initial dose is 5 drops. every 8-12 hours, then a single dose is increased by 5 drops. per week and bring up to 25-40 cap. every 8-12 hours Course duration - 2–4 months	Indication: skin and skin-lymphatic spore-trichosis. May cause "iodism" reactions and changes in thyroid function. It is excreted in large quantities with breast milk, so breastfeeding should be stopped during treatment.
Amorolfine	Lacquer for nails 5% in a bottle. 2.5 ml each (complete with tampons, spatulas and nail files)	-	ND	locally Lacquer is applied to the affected nails 1-2 times a week. Periodically remove the affected nail tissue	Indications: onychomycosis caused by dermatomycetes, yeasts and molds (if no more than 2/3 of the nail plate is affected); prevention of onychomycosis
Cyclopirox	Cream 1% in tubes of 20 g and 50 g Solution 1% in a bottle. 20 ml and 50 ml each Vagina cream. 1% in tubes of 40 g Powder 1% in a bottle. 30 g each	1.3 (local)	1,7	locally Cream or solution is applied to the affected areas of the skin and gently rubbed 2 times a day for 1-2 weeks The powder is periodically poured into shoes, socks or stockings intravaginally The cream is administered with the included applicator at night for 1-2 weeks	Indications: ringworm, onychomycosis (if no more than 2/3 of the nail plate is affected), fungal vaginitis and vulvovaginitis; prevention of fungal infections of the feet. Not recommended for use in children under 6 years of age
Combined drugs
Nystatin/ ternidazole/ neomycin/ prednisolone	Tab. vagina. 100 thousand units + 0.2 g + 0.1 g + 3 mg	ND	ND	intravaginally Adults: 1 tab. overnight for 10–20 days	The drug has an antifungal, antibacterial, antiprotozoal, and anti-inflammatory effect. Indications: vaginitis of candidal, bacterial, Trichomonas and mixed etiology
Nystatin/ neomycin/ polymyxin B	Caps. vagina. 100 thousand units + 35 thousand units + 35 thousand units	ND	ND	intravaginally Adults: 1 caps. overnight for 12 days	The drug combines antifungal and antibacterial action. Indications: vaginitis of candidal, bacterial and mixed etiology
Natamycin/ neomycin/ hydrocortisone	Cream, ointment 10 mg + 3.5 mg + 10 mg per 1 g in tubes of 15 g Lotion 10 mg + 1.75 mg + 10 mg per 1 g vial. 20 ml	-/ 1–5/ 1–3 (locally)	ND	locally Apply to the affected areas of the skin 2-4 times a day for 2-4 weeks	The drug has an antibacterial, antifungal and anti-inflammatory effect. Indications: skin infections of fungal and bacterial etiology with a pronounced inflammatory component
Clotrimazole / gentamicin/ betamethasone	Cream, ointment 10 mg + 1 mg + 0.5 mg per 1 g in tubes of 15 g	ND	ND	locally Apply to the affected areas of the skin 2 times a day for 2-4 weeks	Same
Miconazole / metronidazole	Tab. vag. 0.1 g + 0.1 g	-/ 50 (locally)	-/ 8	intravaginally Adults: 1 tab. overnight for 7-10 days	The drug combines antifungal and antiprotozoal activity. Indications: vaginitis of candidal and trichomonas etiology

* With normal kidney function

** With intravaginal administration. When applied externally, it is practically not absorbed

*** When applied to inflamed skin

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

Amphotericin B, griseofulvin, mycoheptin have a systemic effect and are often prescribed in the treatment of mycoses. With dermatomycosis, antifungal antibiotics griseofulvin, amphoglucamine, nystatin are used.

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

Oxyconazole, Griseofulvin, Tolcyclat, Tolnaftat are used against dermatophytes. The drugs of choice are Naftifin, 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 action of natamycin is manifested 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, skin 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 belongs to antifungal drugs that are allowed during pregnancy and lactation.

Natamycin is not effective against dermatophytes, pseudo-allecheria.

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

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

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

Mycoheptin is toxic, in tablets it is not prescribed during pregnancy and 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 dermatomycete fungi, is one of the main drugs in the treatment of trichophytosis, microsporia of the scalp, favus, nail fungus.

Griseofulvin contains antifungal agents Gritsin, Grifulin, Grifulvin, Fultsin, Fulvin, Grisefulin, Lamoril, Sporostatin.

Griseofulvin is effective when taken orally, in the form of tablets, 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 weight of the patient.

Griseofulvin is not used for candidiasis, is not prescribed during pregnancy, lactation. The drug has a teratogenic effect, the danger to the fetus persists 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, pyrimidines.

Azoles

Antifungal drugs from this group exhibit fungistatic - suppression of fungal reproduction, and fungicidal action.

Fungicidal properties are expressed in the destruction of fungal cells, the effect is achieved only at high concentrations of antimycotics. Azoles include:

• 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, versicolor, subcutaneous and deep mycoses.

Voriconazole is a part of Vfend tablets and powder, Voriconazole, Vikand tablets, Biflurin.

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

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

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

Itraconazole is contained in the preparations Itrazol, Itraconazole, Orungal, Rumikoz, Orunit, Itramikol, Kanditral, Teknazol, Orungamine, 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.

As an active compound, fluconazole contains Mikosist, Diflazon, Mycoflucan, the combined agent Safocid, Diflucan, Flucostat, Fungolon, and the antifungal gel Flukorem.

The group of imidazoles includes both antifungal drugs with well-known properties that have long been used in medical practice, as well as 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 is used to treat genital candidiasis in men and women, the cream has antibacterial activity, and is used for vaginal trichomoniasis.

Third-generation imidazole ketoconazole is similar in efficacy and spectrum of action to itraconazole, but is not active against aspergillus molds, as well as some strains of candida.

Ketoconazole contains antifungal ointments Mycozoral, Perchotal, Sebozol, Mikoket, Nizoral cream and shampoo, Keto plus shampoos for people, Mikanisal.

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

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

The active substance clotrimazole is part of the antifungal agents Candide, Canison, Amiklon, Kanesten, Imidil, Lotrimin, Candizol, Clomegel.

The antifungal agent Candid-B is widely used for the treatment of skin mycoses, and Clotrimazole ointment is used for thrush in men.

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

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

Comparative Features

In the azole group, ketoconazole has the highest hepatotoxicity, the drug is used mainly for local treatment.

Fluconazole is considered a less toxic drug from azoles, however, it can also cause side effects:

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

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

It is prescribed for mycoses different localization, including in the prevention of fungal infection during radiation therapy or treatment with antibiotics.

Allylamines

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

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

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

Terbinafine preparations 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 fungal infections of the smooth skin of the body, legs, head, toenails, and hands.

Medicines with the active substance 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 preparations containing the active substance naftifine include Exoderil cream and solution. Medicines are used to treat skin, nails, applied topically 1 time per day.

Echinocandins

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

Other groups of antimycotics

Preparations with amorolfine Oflomil Lac, Loceryl are used for nail mycoses, candidiasis of nails and skin.

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

Flucytosine

The drug of this group Ankotil is used to treat aspergillosis, unrecorded mycosis, cryptococcosis, candida septicemia.

Chlornitrophenol

Nitrofungin solution is used externally for the treatment of mycosis of the feet, inguinal epidermophytosis, candidiasis, nail fungus, dermatophytosis.

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

External means

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

In the treatment of nail fungus, feet, in order to provide access to the antifungal agent to the lesion, the horny surface layer of the skin is first detached.

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

From the fungus of the skin, nails are treated with antifungal ointments, creams Travocort, Lotriderm, Triderm, Sikorten plus, Sinalar K, Sanguiritrin.

Antifungal varnishes have a deep effect on tissues. Lacquer is a collodion into which a fungus medicine is injected. When applied to nails, skin, a thin film is formed on the surface, which has a therapeutic effect. Nail fungus is treated with varnishes Lotseril, Batrafen.

Have not lost their value in the treatment of fungus ointments containing tar, sulfur, undicylenic acid, alcohol solution iodine, aniline dyes.

For the treatment of scalp, antifungal shampoos Nizoral, Mycozoral, Cynovit, Sebiprox, Mikanisal are used.

For the treatment of fungal infections of the skin of the face, skin folds, scalp, beard, smooth skin of the body, antifungal ointments Nystatin, Amiclon, Lamisil are used.

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

Self-medication with antimycotics is dangerous, uncontrolled use of antifungal agents can cause allergies, dermatitis, and disrupt liver function.

Systemic antifungal therapy causes less side effects while taking vitamins, hepatoprotectors.

Antifungals for children

The delicate skin of newborns, infants, babies up to 3 years of age is more susceptible to fungal diseases than the skin of adults. Diaper rash on the skin serves as an entrance gate to the yeast-like Candida fungus.

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

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

Babies up to a year and older are treated for skin 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 older than 3-5 years are more likely to have skin diseases scalp - microsporia, trichophytosis, known as ringworm, as well as epidermophytosis of the feet.

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

Many plants have antifungal properties.

Antifungal activity is shown by blackcurrant, dill, sage, black tea, ginger, peppermint, lemon. In the absence of allergies in a child, skin folds and diaper rash on the skin are rubbed with weak decoctions of plants.

Drugs for the treatment of mycoses

Fungal diseases are treated comprehensively, several drugs are prescribed to expand the spectrum of action, 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.

Dermatomycosis

• 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.

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

So, new antifungal drugs from the group of echinocandins are not active against cryptococci. The action of echinocandins is enhanced by the appointment of amphotericin B, which suppresses the growth of cryptococci.

Positive results of treatment are noted in the appointment of complex therapy in patients with immunodeficiency states. The combination of antimycotics is selected depending on the type of fungi, aggressiveness, and the patient's condition.

Fungus - plant microorganisms that affect mainly the skin and nail plates. When exposed, the structure of the affected area is destroyed, which is accompanied by pain sensations, bad smell.

To prevent and stop the development of the disorder at an early stage will allow the use of broad-spectrum antifungal drugs, presented in the form of tablets, ointments, mixtures.

Experts focus on the fact that the development of the disease and infection with bacteria occurs with weak immunity or when receiving mechanical damage. Ignoring disinfectants is the first step towards the development of fungal infections.

Attention! Average duration incubation period(time from the moment the pathogen hit to the first symptoms) is 21 days. On the example of nails, it can be noted that after the manifestation of the initial signs until the complete destruction of the nail plate (without the possibility of its treatment and restoration), an average of up to 5 months occurs.

Antifungal drugs with a wide spectrum of action (including tablets) are characterized by a complex effect on the body.

The task of medicines:

• destruction of bacteria;
• prevention of reproduction;
• creating conditions under which infection of other areas of the skin or nails will be impossible.

Treatment is systemic, that is, you additionally need to pay attention to the following points:

• strengthening general immunity;
• healing of damaged tissues.

Antimycotics are a group of drugs used in the treatment of fungus in humans.

Attention! Reception should be carried out only after a doctor's prescription, taking into account the dosage and the deadline for use.

The mechanism of action of antifungal tablets

The mechanism of action of broad-spectrum antifungal drugs

Broad-spectrum antifungal drugs in tablets can act in the following areas:

• membrane destruction at the nucleation stage;
• the accumulation of a chemical drug in the cell with the aim of "clogging" it;
• stopping biosynthesis by destroying RNA and DNA elements;
• suppression of the action of enzymes necessary for cell reproduction.

Active ingredient of antifungal drugs

Depending on the active substance inside medicinal product, and the mechanism of the work of tablets in the body will depend.

Table No. 1 "Qualification of substances by type of active ingredient":

Effect	Fungicidal	fungistatic
Mechanism of influence	The action of the tablets of this group is aimed at the forced stop of cell division, which is accompanied by the directed destruction of a certain set of elements inside the fungus. Deprived of the possibility of biosynthesis, fungi gradually die.	The main task of tablets in this category is to stop cell growth, that is, development stops at a specific stage without the possibility of further reproduction and harmful effects.
Indications for admission	It is advisable to use in relation to an actively developing disease, the active signs of which appeared about a month ago.	They are prescribed by doctors, mainly as soon as possible after incubation.
Active drug	Ketoconazole, fluconazole, griseofulvin.	Itraconazole, terbinafine.

How to take pills correctly

Broad-spectrum antifungal drugs in tablets should be taken taking into account the following features:

Classification of antifungal drugs

In medicine, it is customary to divide all types of fungi into the following groups:

• affecting internal organs;
• damaging surface integuments;
• causing serious consequences;
• flowing in a mild manner.

Azole group

Broad-spectrum antifungal drugs in tablets of this group belong to chemical agents, that is, laboratory medicines consisting of artificial components.

Thanks to synthetic creation, the drugs are equally effective in the following categories of disorders:

Table No. 2 "Classification":

Polyene antifungals

Medicinal tablets of this group have a wide spectrum of action, so they can be equally prescribed for initial stages detection of diseases and with prolonged exposure to the fungus on the body.

Most often, polyene preparations are prescribed for lesions of the mucous membranes. This also applies oral cavity, and diseases of internal organs, intimate places (for example, thrush).

Attention! The product cannot be used to treat dermatological problems.(damage to the skin), since the active substances of the tablets do not have therapeutic action on fungi in this area.

Echinocandins

The mechanism of action is a violation of the cellular structure of the fungus, which prevents the further spread of bacteria, and also contributes to the death of active elements. The group of tablets consists partly of chemical constituents, and partly of natural elements.

The advantage of the agent is its rapid solubility. It means. That after entering the stomach, the tablet quickly dissolves, because the active ingredients begin to act in the next 20-30 minutes.

Allylamine group

What pills to drink from the fungus

Broad-spectrum antifungal drugs in tablets can be prescribed only after consulting a doctor. This is due to the fact that taking one medication will not be enough. A complex effect on fungal bacteria is required, which in parallel stimulates the immune system and restores damaged organs.

As for visiting a doctor, a trip to the doctor will be appropriate not only if visible violations are detected. Sufficiently stable pain sensations that have no obvious cause. Most often this It's a dull pain in the area of ​​the nail plate on the toes. A slight change in the color of the nails will also be the basis for a visit to the doctor.

Attention! Self-medication can lead to the fact that the selected drug will be ineffective for this type of bacteria, so the patient will not only not get rid of the disease, but will also provoke its further spread.

Antifungal drugs for the skin: how to use, cost

Griseofulvin

Do not prescribe the drug for minor stages of the disorder. In addition, it is not allowed to take pills for prevention. It is strictly forbidden to use the drug for pregnant women, since studies have shown that patients who allowed taking pills showed abnormalities in the development of the fetus.

Dosing depends on the characteristics of the course of the disease. The average treatment time is up to two weeks. Approximate cost in pharmacies Russian Federation is 110 - 120 rubles.

Nizoral

It is allowed to take pills for children older than three years, but as side effects there may be temporary disturbances in the work of digestion and nervous system. The average price in the Russian Federation is 750 rubles.

Nystatin

Can be taken by adults and children. The doctor is authorized to prescribe the required dose based on the age of the sick person, the extent of the spread of the bacteria, and also on which organs need to be affected.

If we are talking about adults, then per day for the first time of treatment, you must take four tablets with an equal interval of time. By the end of the course, the number of tablets taken will decrease.

Candiosis pills: rules for taking, price

Natamycin

This is a hypoallergenic antibiotic, which is characterized by a complex effect on the affected organism. It is used in gynecology and is characterized by fast action.

Since pills are used to treat a fungus that affects the genitals, doctors strongly advise against therapy for the period of menstruation.

This is a relatively loyal remedy, since it can be used by pregnant women and while feeding a baby, and studies have shown that there will be practically no side effects.

To purchase a blister of 10 tablets, you will need approximately 250 rubles.

Amphotericin B

One of the most popular drugs, which is characterized by a gentle effect on the human body. At the same time, it is advisable to prescribe the drug only at the initial stages of treatment of the disorder or with minor damage to the patient's organs. The price of the tool varies within 50 rubles.

Vfend

One of the most expensive drugs, the cost of which in the domestic market is approximately 29,000 rubles. Tablets have a quick and complex effect, therefore it is prescribed even for the most severe forms of the disorder.
Due to such efficiency, such a fabulous price is set.

Antimycotics from nail fungus: instructions, cost

it local funds, which actively fight minor manifestations of the fungus, as well as lesions at an early stage. The duration of the drug depends on the patient and the severity of the disease. On average, treatment takes 2-3 weeks.

Fluconazole

It is a jelly capsule, which can be purchased in Russia for about 40 rubles. It is used not only for treatment, but also to prevent disorders in the future. The use of capsules by children who have reached the age of five years is allowed.

Since this is a drug of general action, it is gentle on the body with practically no side effects. Unfortunately, the effectiveness of active substances is only 20%.

Ketoconazole

Like all antibiotics, the drug disrupts the balance of the intestine, so the patient needs to take additional probiotics. It is forbidden to prescribe the drug to children under 12 years of age, pregnant and lactating women.

Itraconazole

With severe ailments, as well as with extensive fungal infection, a person will have to pay up to 2,500 rubles for his treatment. This is a synthetic drug that acts comprehensively on the affected areas of the skin and organs.

Treatment is prescribed for a period of up to a week, since the active components of the tablets have the properties of accumulation in the body, and therefore the preventive effect persists for up to a month.

Terbinafine

2000 rub. for the packaging will cost these pills. The remedy acts in a complex way, additionally stimulating the immune system and eliminating the negative effects of fungi. Along with high efficiency, you need to remember about side effects.
Pills affect the nervous system most of all, so patients may experience hearing or vision impairment.

Children's antifungal tablets: names, instructions, price in pharmacies

Most of the funds in this category are characterized by a significant negative effect on the body, so it should be used with extreme caution in children. Only a pediatrician can determine the treatment and dosage. Self-medication is strictly prohibited, otherwise there may be more harm than good.

The most common drugs in this group include:

Precautions when taking anti-fungal drugs

All drugs in this group are antibiotics, therefore, even with a slight effect on the body, the drugs can cause allergies and disrupt the functioning of the main human systems.

The following measures will help prevent a number of violations:

• refusal of self-treatment (only a doctor can prescribe funds to a patient);
• strict adherence to dosage;
• adherence to a single schedule for taking the medication;
• additional intake of probiotics, which will help reduce the harmful effects on the intestinal tract.

Antifungal drugs of a wide or local spectrum of action (in tablets) cannot always guarantee a quick recovery. This is due to the fact that each organism in its own way can respond to treatment. An alternative way to fight fungi is with ointments and powders for oral consumption.

Article formatting: Mila Fridan

Video about antifungals

Effective drugs for nail fungus:

Content

A huge number of people suffer from fungal infections. Antifungal drugs help get rid of them - special tablets, ointments, creams, suppositories, sprays and solutions for treatment, the action of which is aimed at destroying pathogens and preventing their reproduction. Now there are a huge number of such funds on the market. From defeat different types fungi are not insured by any person, so everyone should know what antimycotic drugs exist.

What are antifungal drugs

This is the name of all drugs that exhibit specific activity against pathogenic fungi, suppressing their activity and destroying them. Antifungal agents are divided into different groups according to the structure of the chemical compound and the spectrum of activity. May contain both natural and chemical ingredients. Available in the form of tablets, ointments, creams, suppositories, sprays. The action of drugs is aimed at destroying pathogens without causing harm to the patient.

The use of antifungal drugs

There are a huge number of types of mycoses. They can affect the skin, nails, mucous membranes. Antifungal drugs are designed specifically to destroy the pathogens of the fungus, to stop its negative impact on the human body. List of the most common mycotic diseases:

• candidiasis;
• pityriasis versicolor;
• cryptococcal meningitis;
• pseudoallescheriosis;
• ringworm;
• dermatomycosis;
• lesions of the nail plates, skin;
• aspergillosis;
• candidal and trichomonas vulvovaginitis;
• sporotrichosis;
• fusarium.

Kinds

There are many types of antifungal drugs. They are divided into groups according to:

• origin (synthetic, natural);
• method of application (internal, external, parenteral);
• mechanism and spectrum of action;
• indications for use (systemic or local infections);
• effect of exposure (fungistatic, fungicidal);
• activity level (broad and narrow spectrum).

Ointments

Local preparations of this type are prescribed, as a rule, in the initial stages of mycotic diseases. Antifungal ointments fight the infection caused by the pathogen, relieve unpleasant symptoms. The advantages of their use:

• a wide range of antifungal agents, both at affordable prices and more expensive;
• ease of use;
• the possibility of acquiring without a doctor's prescription (in most cases).

There are certain groups of ointments according to the area of ​​​​application. General medicines:

1. Zalain. Ointment with sertaconazole. Prevents the spread of pathogens. The course of treatment is a month.
2. Exoderil. Effective ointment, substances which do not penetrate into the blood. It cures the fungus in one to two months, but can cause side effects: allergic reactions, headache, bloating, diarrhea, hives, nausea, vomiting.
3. Candide. Suitable for any area of ​​the skin. Can be used during pregnancy, lactation. Treatment course, lasts up to six months. Contraindicated in case of individual intolerance to the components.
4. Salicylic ointment. Suitable for treating affected skin areas and applying compresses.
5. Ketoconazole. The drug is effective against many fungi, but dangerous because of its toxicity.
6. Mycosan. Contains ketoconazole. Very quickly relieves itching, and the rest of the symptom in about a month.
7. Zinc ointment. The drug does not have side effects. It is used until the symptoms of the fungus are completely eliminated.
8. Lamisil. Contains terbinafine. Eliminates the symptoms of the fungus in a month.

There are a number of drugs in the form of ointments that are designed to treat mycosis in the intimate area:

1. Clotrimazole. This ointment is allowed to be applied not only to the skin, but also to the mucous membranes. The course of treatment is a maximum of 1 month.
2. Nitrofungin. Ointment with chlornitrophenol, which inhibits the growth of the fungus and has an antiseptic effect.
3. Ketoconazole. It is applied to skin and mucous membranes. The course of treatment is 2-4 weeks.

Tablets

Mycosis, especially in advanced stages, will not go away without systemic treatment. Pills for fungal diseases can destroy the pathogen or block its action, so they are more effective than any local drugs. Such funds are allowed to be taken only as directed by a doctor and at the same time strictly follow his instructions, because they have many contraindications and side effects. The list of drugs in tablets is very wide, so it is most convenient to divide them into groups according to the active substance.

1. with ketoconazole. Prevents the growth of fungi. Antimycotic drugs with this active substance in the composition: Nizoral, Ketozol, Dermazol, Ketozoral, Ketoconazole, Mycozoral.
2. with itraconazole. This substance is especially effective against dermatophytes, molds and yeasts. It contains such tablets: Itraconazole, Itrungar, Orungal, Sporagal, Itracon, Eszol, Isol.
3. with terbinafine. A substance that disrupts the viability of a fungus. Taking drugs with it is effective for dermatomycosis of any part of the body. It is a part of such tablets: Lamisil, Binafin, Terbinafine, Lamikon.
4. with fluconazole. The substance is a derivative of triazole with a pronounced antifungal effect. Fluconazole tablets are especially effective against yeast fungi. Suitable for the treatment of onychomycosis, candidiasis of the mucous membranes. The list of tablets with this substance: Fluzon, Fluconazole, Medoflucon, Futsis, Mikosist, Difluzol, Diflucan.
5. Griseofulvin. Tablets have the same name as the main active ingredient in their composition. The systemic drug is effective against trichophytons, microsporums, epidermophytons. Suppresses the process of cell division of the fungus. Contraindicated in pathologies of the heart, renal failure, disorders of the nervous system.

Creams

Preparations in this form of release have a local effect. Creams differ from ointments in that they contain less fat in the composition. They are quickly absorbed and soften the skin. List of effective antifungal creams:

1. Nizoral.
2. Tinedol. Contains climbazole and many excipients. Restores skin cells, heals, disinfects. Suitable for the treatment of fungus and prevention.
3. Microspore.
4. Terbinafine. Helps with fungal infections of the feet, skin, mucous membranes, nails. Apply a thin layer to the infected area. The duration of treatment, depending on the severity of the lesion, can range from several weeks to six months.
5. Lamisil.
6. Naftifin. Effective for inguinal epidermophytosis, onychomycosis, candidiasis.
7. Ketoconazole.
8. Clotrimazole. Helps against mold, yeast fungi, dermatophytes. It is not recommended for use during pregnancy and in case of hypersensitivity to the components. Cream treatment is a month and a half.
9. Lotseril.

Capsules

Preparations released in this form practically do not differ in the principle of action from tablets. What antifungal capsules exist:

• Fluconazole;
• Orungal;
• Rumikoz;
• Itrazol;
• Irunin;
• Diflazon;
• Diflucan;
• Mycomax;
• Mycosist;
• Flucostat;
• Forkan.

Candles

Preparations in this form are prescribed to women from thrush. The disease is caused by yeast-like fungi. Its symptoms appear in the intimate area. Vaginal (in rare cases, rectal) suppositories help to get rid of them as quickly as possible. They are made from medicinal and additional components that allow suppositories to remain solid at room temperature. Suppositories are convenient to use. They act locally and do not harm the kidneys, liver, organs of the digestive system.

List of the most effective candles:

• Pimafucin;
• Zalain;
• Livarol;
• Ginezol 7;
• Guino-Pevaril;
• Hexicon;
• Betadine;
• Metronidazole;
• Osarbon;
• Nystatin;
• Gino-Dactanol;
• Ketoconazole;
• Viferon;
• Klion-D;
• Terzhinan;
• Polygynax;
• Lomeksin.

Classification

There are many features by which antimycotic drugs are categorized. It is more common to combine them by chemical group and pharmacological activity. This classification helps the specialist to choose and recommend to the patient the drug that will be most effective in treating the diagnosed type of fungus. Allocate antifungal agents of a wide and narrow spectrum of action.

Azole group

Synthetic antifungal agents that have fungicidal and fungistatic effects. They help in the treatment of mycoses of the skin, nails, mucous membranes, scalp. Group representatives:

1. Ketoconazole (analogues of Fungavis, Oronazole, Nizoral, Mycozoral). Effective against yeast-like, dimorphic, higher fungi, dermatophytes.
2. Voriconazole (Vfend, Biflurin, Vikand). Drugs effective for candidiasis, versicolor, aspergillosis, deep subcutaneous mycoses.
3. Itraconazole (Irunin, Orunit, Itrazol, Rumikoz, Itrazol, Orungal, Kanditral). They are prescribed for severe lesions of mold, candida fungi.
4. Fluconazole (Diflucan, Mikoflucan, Medoflucon, Mikosist, Diflazon, Mikoflucan, Mykosist, Mikomax). Drugs that inhibit the growth and reproduction of fungi.

Polyene antibiotics

This group of drugs has the widest spectrum of action. They are prescribed to patients who have a weakened immune system. Representatives:

1. Nystatin. Effective against candidiasis of the skin, oral cavity and pharynx, intestines.
2. Levorin. A drug with a wide range of indications, especially effective against candidiasis and protozoan fungi.
3. Pimafucin. A drug that has a fungicidal effect on molds and pathogenic yeast fungi.
4. Amphotericin B (Ambizom, Fungizone, Amphoglucamine, Ampholip, Amphocil). It is used for progressive fungal infections that pose a serious threat to life.

Allylamine group

Synthetic antifungal agents effective against dermatomycosis affecting nails, hair, skin. Allylamine group drugs:

1. Terbinafine (Lamisil, Terbinox, Bramisil, Terbizil, Exitern). It is effective in dermatomycoses that have affected areas of the body that are significant in size.
2. Naftifin (Exoderil). Effective in fungal diseases of nails and skin caused by sensitive pathogens.

Antifungals for children

The child's body is at increased risk of mycotic lesions because they the immune system still works flawlessly. However, not all drugs are suitable for the treatment of pediatric patients. If the child has become infected, then the doctor should select the antifungal medicine for him, determining the type of pathogen and conducting additional diagnostics. What drugs can be prescribed to children:

1. Local. Mycosan, Nystatin, Amorolfine, Lamisil.
2. Systemic. Griseofulfin, Mikoseptin, Flucytosine, Terbinafine, Flucytosine, Fluconazole.

Broad Spectrum Antifungals

Such drugs have both fungicidal and fungistatic effects. They prevent the reproduction of the fungus and destroy existing pathogens. Depending on the active substance, each drug works in its own way:

1. Ketoconazole (Oronazol, Fungavis, Mycozoral). Interferes with synthesis of components of a cellular membrane of a fungus.
2. Griseofulvin. Prevents the division of fungal cells.
3. Itraconazole (Irunin, Orunit, Orungal). Prevents the formation of ergosterol (a component of a fungal cell).
4. Terbinafine. Prevents the synthesis of ergosterol at the initial stage.
5. Fluconazole (Diflucan, Fluxstat, Mycomax). Prevents the formation of new spores and eliminates existing ones.

How to choose

If you find a fungus, then the most reasonable thing to do is to consult a dermatologist. The specialist will determine the type of pathogen, assess the degree of damage and the general condition of the body. After analyzing the data, he will develop a therapy strategy, recommend you the most effective and safe drugs. Self-medication can not only not give a positive effect, but also harm your body.

Price

You can order drugs in an ordinary pharmacy, buy in an online store, choosing the option that suits you in the catalog. The price depends on a wide range of factors. The approximate cost of some drugs can be found in the table below:

Name of the antifungal drug	Approximate price in rubles
Cream Zalain, 2%, 20 g
Cream Exoderil, 1%, 15 g
Diflucan, 1 capsule
Irunin, 14 capsules
Griseofulvin, 20 tablets
Itraconazole, 14 capsules
Livarol, vaginal suppositories, 10 pcs.
Nystatin, 10 vaginal suppositories
Rumikoz, 6 capsules
Terbinafine, ointment, 15 g
Fluconazole, 7 capsules

Video

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment, based on individual characteristics specific patient.

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Antifungal drugs - effective and inexpensive

Content

Most people have experienced itching near the nails, reddening of the lateral ridges, and an unpleasant smell from the feet, but this is not the only type of fungal infection - only the most common. If the lesion covers a large area or has affected internal organs, local treatment is indispensable: tablets are needed.

What are antifungal drugs in broad spectrum tablets

Antimycotics - the so-called drugs that have a fungistatic (suppress activity) or fungicidal effect (kill) on fungal microorganisms. They can be natural or synthetic, narrowly targeted or broad spectrum, meaning they are effective against several groups of fungal microorganisms. Systemically (tablets) they are prescribed for:

• severe course of the disease;
• extensive area of ​​damage;
• infection of internal organs;
• the need to protect yourself from a fungal disease (with a high risk of infection).

The main advantage of such systemic drugs is their effectiveness - they act on several different pathogens at once and do it quickly, suitable for a severe infection. The downside is high toxicity, a large number of contraindications and side effects, so you need to carefully consider the doctor's recommendations and the prescribed regimen. Broad-spectrum antifungal drugs in tablets can cause:

• liver damage (hepatotoxic);
• estrogen fluctuations;
• severe allergic reactions;
• anaphylactic shock.

How to use

Antifungal drugs with a wide spectrum of activity for systemic treatment can be used parenterally (dropper solution) or orally. The specific scheme of application depends on the active substance, the form of the disease, the patient's condition. A few key points:

• Suction allylamines does not depend on food intake, so they can be taken at any time, and azoles - always with meals. It is advisable to use antibiotics not on an empty stomach in order to reduce the likelihood of mucosal irritation.
• Antimycotics it is advisable to drink only clean water. An exception is the situation of treatment with azoles in patients with low stomach acidity: they should take the pill with an acidic liquid (tea, pasteurized milk).
• Griseofulvin should be taken with a tablespoon of vegetable oil, especially if the patient is on a low-fat diet.
• Antifungals use according to the schedule, observing the time of admission and intervals (necessarily equal intervals). If you forget, take the pill as soon as you remember, but do not increase the single dose.
• Capsules cannot be destroyed (cut, pour out the contents). The tablet can be divided if necessary to reduce the dosage.

Classification of broad-spectrum antifungal drugs in tablets

Official medicine has several ways of dividing antimycotics into categories. By origin, they are synthetic (artificial) and natural. The classification by chemical structure (active substance) is more extensive:

• Azoles: derivatives of triazole, imidazole.
• Allylamines.
• Echinocandins.
• polyene antibiotics.
• Preparations of other chemical groups: ciclopirox, griseofulvin, flucytosine.

Antifungal antibiotics

Antibiotics of the polyene macrolide group have the widest spectrum of action and high efficiency in the fight against fungus - they do not affect only dermatomycetes with pseudo-allescheria. They mainly destroy representatives of the genus Candida, but can also be active against filamentous and dimorphic fungi, trichomonas, amoebas, leishmania. Known polyenes in tablets:

• Amphotericin B;
• Levorin;
• Nystatin;
• Mycoheptin;
• Natamycin.

All of them work by binding to the fungal cell membrane with ergosterol, which leads to a violation of its integrity and subsequent lysis (death) of the cell. Each of the polyene antibiotics has its own spectrum of activity and a list of organisms sensitive to it, so they are not interchangeable. When taking tablets, active substances from the gastrointestinal tract are almost not absorbed. A highly effective antifungal drug of this type is Pimafucin, which does not have a systemic effect, working only in the digestive tract:

• Active ingredient: natamycin.
• Indications: non-invasive intestinal candidiasis (treatment / prevention), including those caused by drug therapy.
• Side effects: in the first days of use, diarrhea, nausea.
• Contraindications: intolerance to the active substance.

A powerful representative of polyenes is Levorin, which is active against yeast-like fungi, is prescribed for a long course (for 10-12 days). If necessary, the treatment is carried out twice. Features of Levorin:

• Active ingredient: levorin.
• Indications: gastrointestinal candidiasis, carriage of fungi of the genus Candida.
• Side effects: diarrhea, nausea, vomiting, loss of appetite, headache.
• Contraindications: hepatic or renal insufficiency, hypersensitivity, pancreatitis, ulcer, acute diseases intestines (not fungal etiology), pregnancy. With caution, it is allowed to use Levorin in children under 2 years of age and while breastfeeding.

Nystatin is a cheap polyene antibiotic on the same name. active substance, which can be prescribed not only for the active treatment of a fungal infection, but also for the prevention of infection. Key points:

• Active ingredient: nystatin.
• Indications: candidiasis of the skin, mucous membranes, internal organs. Long term treatment antimicrobial agents(prevention).
• Side effects: nausea, vomiting, pruritus, temperature rise.
• Contraindications: peptic ulcer, pancreatitis, liver problems, pregnancy, compound sensitivity.

Among the antifungal antibiotics of the non-polyene group, doctors single out the drug Griseofulvin: it works on a substance of the same name that has a fungistatic effect. It is produced by mold fungi, causes disruption of cell wall synthesis, inhibits cell division and protein production. It tends to accumulate in the cells of nails, hair and skin. Features of Griseofulvin tablets:

• Active ingredient: griseofulvin.
• Indications: dermatophytosis of the scalp, epidermophytosis (trichophytosis) of the hands and feet.
• Side effects: dyspepsia, headaches, dizziness, urticaria, leukopenia, increased levels of eosinophils.
• Contraindications: uterine bleeding, malignant tumors, disorders of the kidneys and liver, porphyria (disturbance of pigment metabolism), problems with cerebral circulation, lactation and pregnancy, systemic lupus erythematosus, changes in blood composition.

Synthetic antimycotics

The appointment of polyene antibiotics (or non-polyene) is rare - mainly antifungal drugs in capsules or tablets belong to the group of synthetic antimycotics. It is represented by the following categories of drugs:

• azoles;
• allylamines;
• echinocandins;
• drugs of the rest medicinal groups(cyclopirox, flucytosine, amorolfine).

Azoles

Broad-spectrum drugs from the category of azoles have a fungicidal effect (destroy cells) on the fungus, if used in high doses, and fungistatic (do not allow to multiply) in low ones. These medicines are also divided into groups (the names of medicines are given for the most used active substances):

• Triazole derivatives: miconazole (Daktarin, Klion D), ketoconazole (Oronazol, Nizoral, Fungavis), isoconazole, oxinazole, clotrimazole (Candide, Antifungol), bifonazole, sertaconazole, fenticonazole.
• Imidazole derivatives: vorkinazole (Vikand, Vfend), itraconazole (Orungal, Irunit), fluconazole (Diflucan, Flucostat).

Most of the azole preparations are used in the treatment of mycoses of the scalp, hands and feet, to combat lichen and especially thrush (vaginal candidiasis), since such tablets are highly effective against the Candida fungus. Among the most popular drugs from the azole group, doctors singled out the most non-toxic and approved Flucostat during pregnancy:

• Active ingredient: fluconazole.
• Indications: candidiasis of the mucous membrane of the eye, vagina, internal organs (including prophylaxis in the treatment of antibiotics), pityriasis versicolor, mycosis of the feet.
• Side effects: dizziness, headache, diarrhea, nausea.
• Contraindications: hypersensitivity to azoles, age up to 3 years, taking hepatotoxic drugs, breastfeeding.

Mycozoral among the other azoles is considered the most powerful (concerns the central component), therefore it is used mainly where treatment with other antimycotics did not work. Key points:

• Active ingredient: ketoconazole.
• Indications: deep mycoses, lesions of the scalp with dermatophytes / molds, versicolor, chronic superficial candidiasis, systemic infections (histoplasmosis, blastomycosis).
• Side effects: menstrual disorders, toxic hepatitis, loss of appetite, hemolytic anemia.
• Contraindications: liver disease, childhood up to 3 years, intolerance to any component of the composition. Tablets require care when combined with other medicines.

Biflurin tablets (as well as other drugs on vorkinazole) are little known, they can be the drugs of choice in case of intolerance to other azoles (or lack of effect from them). Peculiarities medicinal product:

• Active ingredient: vorkinazole.
• Indications: invasive aspergillosis, severe forms of invasive candidiasis.
• Side effects: peripheral edema, chills, fever, chest pain, nausea, vomiting, indigestion, anemia.
• Contraindications: hypersensitivity, taking rifampicin, barbiturates, efavirenzine, ergot alkaloids.

Allylamines

The elimination of dermatomycosis (on the skin of the body, head) and onychomycosis is the main effect of drugs from the allylamine group, which include only 2 substances: naftifine and terbinafine. Tablets are released only on the latter and there are a large number of them:

• Fungoterbin;
• Exifin;
• Binafin;
• Thermikon;
• Mycoferon;
• Lamisil.

In the group of allylamines, terbinafine is considered more common and effective: it has a wide spectrum of action, is able to eliminate infections caused by protozoa (leishmaniasis, trypanosomiasis), deep mycoses, pityriasis versicolor. Naftifine (Exoderil) works only locally. Allylamines act by inhibiting the synthesis of ergosterol and destroying the shell of fungal spores, which leads to the death of the infectious agent. Low dosages are effective against molds and dimorphs. The most famous allylamine is Lamisil:

• Indications: dermatophytic onychomycosis, fungal infections of the scalp, feet, legs, candidiasis. With multi-colored lichen, the effectiveness is low.
• Side effects: headache, dizziness, change in taste perception, loss of appetite, abdominal pain, urticaria.
• Contraindications: hypersensitivity to the composition, chronic / acute liver disease, impaired renal function.

Most allylamines have approximately the same spectrum of action due to the same central component in the composition (they differ only in dosages and additional substances, therefore, to replace the expensive (due to its wide popularity) Lamisil, you can purchase a more budgetary Termikon:

• Active ingredient: terbinafine.
• Indications: mycoses of the scalp (trichophytosis, microsporia), skin and nails, severe extensive ringworm of the body, superficial candidiasis (not internal organs).
• Side effects: nausea, digestive problems, stool problems, skin manifestations of allergies, muscle or joint pain.
• Contraindications: pregnancy, lactation, alcoholism, inhibition of hematopoiesis, disorders of the liver / kidneys.

Close in cost to Termikon and Exiter, which, by analogy with all tablets on terbinafine, requires careful attention to the instructions, since it can affect cardiovascular system. Features of the drug:

• Active ingredient: terbinafine.
• Indications: mycosis of the skin and nails, candidiasis of the mucous membranes.
• Side effects: jaundice, drug-induced hepatitis, muscle, headache or joint pain, nausea, vomiting, skin rash, taste disturbances.
• Contraindications: elderly age, disorders of the liver / kidneys.

Echinocandins

A new category of broad-spectrum antifungal agents are echinocandins, presented in a small assortment. They have not been fully studied by specialists, therefore they are prohibited for patients under 18 years of age, during pregnancy and lactation. Echinocandins work through the blockade of the synthesis of a fungal cell component, which disrupts the process of its construction. In this category, antifungal drugs are present only in powder (tablets are not available). The most studied is Cancidas:

• Active ingredient: caspofungin.
• Indications: candidiasis (strains insensitive to azoles), aspergillosis, suspected fungus in patients with febrile neutropenia (a sharp decrease in the level of neutrophils in the blood).
• Side effects: headache, chills, fever, nausea, abdominal pain, diarrhea, anemia, increased bilirubin levels, tachycardia, shortness of breath, skin rash with itching.
• Contraindications: age up to 3 months. Persons with hepatic insufficiency should be careful when taking.

Less well-known is the drug Mikamin, presumably even less toxic for children (there is no strict ban on use in the instructions, it is allowed to use the drug for a fungal rash on the buttocks of a child). Most doctors prescribe Mikamin to patients over 16 years of age. Features of the tool:

• Active ingredient: micafungin.
• Indications: Prevention or treatment of candidiasis, including candidal stomatitis.
• Side effects: leukopenia, anemia, increased number of eosinophils and bilirubin, hypokalemia, headaches, nausea, diarrhea, abdominal pain.
• Contraindications: intolerance to any component of the composition.

Eraxis, in comparison with other echinocandins, is the most budgetary representative of this group, since 100 ml of lyophilisate cost 5700-6000 rubles. - Mikamin in the same volume will cost the consumer 15,000 rubles. Cancidas next to him (14,000 rubles for 70 g). Eraxis Features:

• Active ingredient: anidulafungin.
• Indications: candidiasis (including damage to the esophagus).
• Side effects: skin allergic reactions, bronchospasm, shortness of breath, decreased pressure (occurs rarely), diarrhea.
• Contraindications: sensitivity to any echinocandins.

Other groups

Most dermatologists, when selecting antifungal drugs in tablets or capsules for systemic treatment of an infection, choose from the categories presented above. Azoles, allylamines, echinocandins and polyenes cope with most mycoses, but in rare cases it is necessary to turn to drugs from other groups. They have a less wide spectrum of action, but are often not so dangerous for the body. The only drug for systemic intravenous use is Ankotil:

• Active ingredient: flucytosine (fluorinated pyrimidine).
• Indications for use: has a fungicidal and fungistatic effect against pathogens of candidiasis, cryptococcosis, chromoblastomycosis (the main indications for use), disrupts the synthesis of fungal DNA. For aspergillosis, it is used with amphotericin B.
• Contraindications: The drug is non-toxic, prohibited in chronic renal failure, blood diseases. The teratogenic effect was found only in rats, so the question of using Flucytosine during pregnancy is decided by the doctor.
• Side effects: nausea, vomiting, diarrhea, dry mouth, stomach bleeding, headaches, dizziness, acute kidney failure, severe weakness, fatigue, allergic reactions, fever.

As an antifungal agent (but not with a wide spectrum of activity), Potassium iodide, which is available in the form of eye drops and is used externally, can also be prescribed by a doctor. The solution is not used orally, if there is no iodine deficiency established by the results of the analysis. Before use, you need to know:

• Active ingredient: potassium iodide.
• Indications: lesions of the cornea, pathological conditions conjunctival, which are caused by a fungus.
• Contraindications: neoplasms of the thyroid gland, kidney disease, hypersensitivity to iodine (and its excess in the body), acne.
• Adverse reactions: increased lacrimation, burning, disruption of the thyroid gland, redness of the mucous membrane of the eyes, blurred vision.

What antifungal drugs for internal use are prescribed

The choice of drug is determined by the specific pathogen, since even broad-spectrum tablets are not absolutely universal. So azoles are mainly used for lichen, onychomycosis, lesions of the scalp, and antibiotics are needed for extensive damage or systemic infection. Self-selection of an antifungal agent is prohibited, since this can aggravate the situation - the pathogen mutates and becomes resistant. To select a drug, you need to laboratory research and get checked out by a dermatologist.

For deep mycosis

Population of pathogenic microorganisms in bone tissues, nervous system, internal organs, respiratory tract requires the use of immunomodulatory drugs. Such severe infections include coccidioidomycosis, cryptococcosis, blastomycosis, histoplasmosis. Among the broad-spectrum antifungal agents, doctors distinguish polyene antibiotics and some azoles (miconazole, ketoconazole, itraconazole, fluconazole):

• Itraconazole- medicine in capsules, with systemic fungal infections, it is used for 2-12 months (check with your doctor). The exact dosage depends on the specific disease and condition of the patient. Mostly adults are recommended 200 mg / day one-time.
• Ketoconazole DS- the dosage is calculated according to the patient's weight: 30 kg or more - 200-400 mg, less - 4-8 mg / kg. The daily dose is taken as a single dose. Used for 4 weeks or longer (determined by physician).

Treatment with intravenous administration of medicinal solutions is considered more effective - polyenes and azoles are also used here. Vorkinazol-Sandoz was highly appreciated by doctors, the dosage of which is set individually. It is worth paying attention to:

• Flucorus (fluconazole)- 50-400 mg, the frequency of use is 1 r / day. In case of impaired renal function, the dosage is determined individually. The duration of therapy depends on clinical picture diseases.
• Amphotericin B (or Ampholip)- the release form is not a tablet, but a powder for infusion (intravenously), which is done at a frequency of 20-30 drops / min. Adult dosage is 250 U / kg, but at the first application, 100 U / kg are made. The concentration of the solution is 100-125 IU per 1 ml of water for injection. Treatment lasts 4-8 weeks with the use of the drug every other day or 2 r / week.

With epidermomycosis

Skin infection requires active local treatment - the use of systemic antifungal agents is considered an additional step in the main therapy. Here, the non-polyene antibiotic Griseofulvin, synthetic antimycotics on terbinafine, Chlornitrophenol are used. Iodine preparations (potassium iodide) are allowed. Your doctor may recommend these broad-spectrum antifungal tablets:

• Exifin (terbinafine)- is prescribed for 2-4 weeks or more, 250 mg per day after meals. In case of renal / hepatic insufficiency, reduce the dose by 2 times.
• Itraconazole- with dermatomycosis, tablets are drunk at 200 mg / day for a week or 100 mg / day for 15 days. With lichen, only a weekly version with a high dose is practiced.
• Griseofulvin- the daily dosage for adults is 500 mg (taken at a time or divided into several servings), in case of severe illness, it is determined by the doctor. The course of treatment lasts 4-6 months if mycosis is on the fingers, 2-4 weeks for the body, 4-6 weeks for the scalp and feet. It is possible to increase up to a year with a severe form of dermatomycosis.

With candidiasis

Yeast infection of the genital organs (vaginal thrush), intestines, oral mucosa is eliminated mainly with the help of 2 categories of broad-spectrum antifungal agents: polyene antibiotics and azoles. Candidiasis responds to the following medications:

• Levorin- adults from candidiasis are recommended to drink 500 thousand units up to 4 r / day. The duration of treatment is 10-12 days.
• Nystatin- dosage for adults with candidiasis of internal organs: 500 thousand units with a frequency of 4-8 r / day, therapy lasts 2 weeks. If the infection is generalized, the dose is increased to 6000 thousand units per day (divided into 4-8 doses).
• clotrimazole- vaginal tablets are used for 3 days, 1 pc. morning and evening or just before bedtime, but for a whole week. If there is no effect, the doctor must adjust the therapeutic course. If necessary, treatment is extended.
• Miconazole- used for intestinal candidiasis at a dosage of 120-240 mg with a frequency of 4 r / day, is prescribed for 10-14 days.
• Fluconazole (analogue - Diflucan)- the most famous pills for recurrent thrush, are taken at 150 mg on the 1st, 4th and 7th day, and after 50 mg weekly for six months.

The severe course of a fungal infection, especially candidiasis of the internal organs, requires the use of solutions for droppers. Such dosage form have the following broad-spectrum antimycotics:

• Fluconazole- 200-400 mg / day, treatment lasts 6-8 weeks. A dropper is placed every day once.
• Miconazole- With caution, adults are prescribed 10 mg / kg intravenously (one-time no more than 600 mg). Dilute the solution with sodium chloride. The duration of the use of droppers is determined by the doctor.
• Micafungin-Nativ- with candidiasis of the esophagus intravenously, adults are prescribed 150 mg / day. The number of procedures is set individually.

For the treatment of fungal infections in children

Pediatricians recommend treating a child with topical medications whenever possible, since most broad-spectrum antifungal tablets are toxic. Ingestion is advisable for candidal stomatitis (tablets and lozenges), large lesions for other mycoses and active progression of the infection. The doctor should prescribe the therapeutic regimen - do not select such medicines for the baby yourself. In children, systemically can be used:

• Lamisil (terbinafine)- children over 3 years of age 125 mg / day (if the weight is 20-40 kg) or 250 mg / day (weight 40 kg or more). Dosages for tablets and intravenous solution are similar. The course of treatment is individual.
• Fluconazole- single use, calculate the dose by weight: 6-12 mg / kg, with food candidiasis once 3 mg / kg. For tablets and intravenous solution, the calculation is the same. The duration of therapy is from 2 weeks.
• Amphotericin B- the initial daily dose of the solution is 0.25 mg / kg (dilute with dextrose 5%), gradually increase it to 1 mg / kg (step - 0.125 mg / kg every other day). Application once a day, the duration of use is determined by the doctor.

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