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Micro - Antifungals (i) (intro (Tx may involve... (drainage, debridement…
Micro - Antifungals (i)
intro
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Tx may involve...
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debridement (removal of dead/damaged/infected tissue to improve healing potential of remaining tissue) - e.g. surgical lung resection in aspergilloma
fungi are eukaryotes - challenges in developing non-toxic antifungals (specific for fungal cell but not host cell)
pharma have put major investment into developing new + improved antifungals instead of antibacterials
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MOAs
action on membrane
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polyenes (amphotericin B, nystatin, abelcet, ambisome, amphotec) disrupt ergosterol
azoles (fluconazole, miconazole, ketoconazole, itreconazole, voriconazole, posaconazole, isavuconazole) + terbinafine disrupt biosynthesis
action on wall
interfere with beta1,3-glucan synthesis
e.g. echinocandins - caspofungin, micafungin, anidulafungin
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Polyenes
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IV admin = amphotericin B lipid formulation (for systemic infection) - e.g. ambisome (liposomal amphotericin B)
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Azoles
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systemic/oral/parenteral admin: fluconazole, voriconazole, posaconazole, isavuconazole
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posaconazole
active against all candida, aspergillus + mucorales
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reserved: ketoconazole, itreconzole, voriconazole, posaconazole, isavuconazole
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