Overview Of Drugs For Treating Fungus, Yeast, And Candida Infections

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Fluconazole (Diflucan)

(a triazole )

IV, Oral Fungistatic against Candida, not fungicidal.
Well tolerated.
15%C. glabrata completely resistant to fluconazole
C. krusei is intrinsically resistant to fluconazole.
Std dose = 400mg/d; if C glabrata, dose should be 800 mg/d
Doses can be as high as 12 mg/kg — for a 150 lb. person
(70 kg)  = 840 mg/d)
For vulvovaginal candidiasis 150 mg single dose therapy
Only azole to cross blood-brain barrier to treat central nervous
system infections

Voriconazole (Vfend)

(a triazole )

IV, Oral New, structurally similar to fluconazole
Fungistatic against Candida, not fungicidal
Enhanced activity against fluconazole-resistant C. Glabrata
Dose at 200 mg/twice day

Itraconazole (Sporanox)

(a triazole )

IV, Oral (Capsules & Oral Solution) Fungistatic against Candida, not fungicidal
Highly lipophilic – poor penetration into aqueous fluids
Capsule form has unpredictable absorption
— Oral Solution preferred
Dose at 100-400 mg/d. For 400 mg/d take 200 mg/twice/day

CCWS Candida Cleanser


Topical, oral  more info



(an imidazole)

Oral Fungicidal against Candida.
Available as a troche (lozenge) for oropharyngeal Candidiasis
Dosage: 10 mg five times per day

Miconazole (Monistat)

(an imidazole)

Topical, oral gel Effective against Candida – fungicidal at
higher dosages.

Widely used topically for skin and vaginal yeast infections
Oral gel used for oral Candidiasis in some countries.
Not absorbed well orally — not generally available in this form.
No hormonal side effects.
No hepatoxicity (liver)
Frequent hypersensitivity – fever and chills, skin rash or itching



Oral Fungistatic, not fungicidal
Transports in aqueous media. Complements lipophilic drugs.
Use in combination with another drug to avoid building
Resistance by Candida is possible.
Dose at 25-37.5 mg/kg four times daily (100-150 mg/kg/day).

Nystatin (Mycostatin, Nilstat)

(a polyene)

Oral tablets, powder, solution Not absorbed. Useful for GI infections only.
4 tabs (500,000 IU’s each) four times daily or equivalent oral
suspension (500,000 IU’s per 5 ml)



(a polyene)

IV Fungicidal
High toxicity to liver – most toxic anti-microbial in clinical use
AmB is the most potent antifungal available.
AmB Not absorbed by GI tract — must use IV formulation for
systemic treatment



(a polyene)

IV Fungicidal
Lipid formulation of AmB
Can deliver higher concentrations with lower toxicity than


(a polyene)

Oral solution, Capsule Fungicidal
No longer available in capsule & suspension forms in US
except from compounding pharmacies
Oral AmB absorption is negligible, not for systemic use
— for GI infections only.
AmB is the most potent antifungal available.
Safe: Oral formulation for GI infections avoids toxicity
of IV formulation.
Oral suspension: 100 mg (1 ml) four times daily
Capsule: 250 – 500 mg four times daily

Caspofungin (Cancidas)

IV Recently approved, esp. for life-threatening fungal infections.
Fungicidal for Candida spp.

Terbinafine (Lamisil)

Oral, Topical Mainly effective on dermatophytes (skin fungi)
Active against Candida in vitro.
Highly lipophilic – poor penetration into aqueous fluids
Has been combined with fluconazole to treat
fluconazole-resistant Candida
Typical dose 250 mg/d, systemic dose 250-500 mg once daily

Ketoconazole (Nizoral)

(an imidazole)

 Oral  Fungistatic against Candida, may be fungicidal
at high doses

Highly lipophilic – poor penetration into aqueous fluids
Stronger liver toxicity than for fluconazole or itraconazole.
Less toxic than amphotericin-B; used for similar fungal
May decrease testosterone and cortisol levels
Dose at 200-400 mg once/day. Can increase to 600-800
mg/day with increased risk of toxicity

candida cell wall suppressor