Oral antifungal medication

Introduction

Oral antifungal medications may be required for fungal infection if:

• It is extensive or severe.
• It resists topical antifungal therapy.
• It affects hair-bearing areas (tinea capitis and tinea barbae).

The choice of oral antifungal medication, its dose and the duration of treatment depend on:

• The type of fungus i.e. candida, dermatophyte (tinea), malassezia, or mould.
• The site affected i.e. skin, mucosa, nails.
• Other co-existing diseases.
• Interactions with other medications.

Medication for both candida and dermatophyte infections (azoles)

The trade names of the medications sold in New Zealand are given in parentheses.

• Itraconazole (Sporanox® capsules).
• Ketoconazole (Nizoral® tablets).
• Fluconazole (Diflucan® capsules).

Voriconazole (Vfend® tablets) and posaconazole are reserved for serious invasive Candida and mould infections.

Some species of candida are resistant to azoles, and azole resistance is increasing especially in immunosuppressed patients who are prescribed long courses.

Medications only suitable for candida infections

• Nystatin (Mycostatin®, Nilstat®), a polyene. This is not absorbed into the bloodstream through the gut.
• Flucytosine (Alcobon® infusion), usually used with amphotericin. It can cause bone marrow depression.
• Amphotericin B (Ambisome® injection; Fungizone® infusion), a polyene. This is not absorbed into the bloodstream through the gut.
• Caspofungin, anidulafungin and micafungin (echinocandins)

Medications only suitable for dermatophyte infections

• Griseofulvin (no longer available in New Zealand), derived from Penicillium
• Terbinafine (Lamisil®, Terbafin® tablets), an allylamine.

Antifungal drug resistance

In recent years, both topical and oral allylamine and triazole antifungal drug resistance has become a problem, particularly in the Indian subcontinent.

Extensive therapy-resistant dermatophyte infection should prompt this as a possible problem. Where available, fungal culture and estimation of drug minimum inhibitory concentration determined to guide appropriate medication

For more information, see antifungal drug resistance.

Approved datasheets are the official source of information for medicines, including approved uses, doses, and safety information. Check the individual datasheet in your country for information about medicines.

We suggest you refer to your national drug approval agency such as the Australian Therapeutic Goods Administration (TGA), US Food and Drug Administration (FDA), UK Medicines and Healthcare products regulatory agency (MHRA) / emc, and NZ Medsafe, or a national or state-approved formulary eg, the New Zealand Formulary (NZF) and New Zealand Formulary for Children (NZFC) and the British National Formulary (BNF) and British National Formulary for Children(BNFC).