Nystatin

Mechanism of action
Nystatin is a polyene antifungal that is effective only against
Candida.
Clinical use
It is poorly absorbed and thus reserved for topical treatment
of oral thrush, vaginal infections, intestinal infections, and
cutaneous infections.
Adverse effects
Gastrointestinal upset is common when nystatin is taken
orally.

Natamycin
Mechanism of action
Natamycin is a polyene antifungal that is used for ocular
infections.

Azoles
Azole antifungals (imidazoles and triazoles) have slightly
different chemical structures, but they all inhibit biosynthesis
of ergosterol, the main sterol in fungal cell membranes (see
Fig. 4-8). Disruption in ergosterol synthesis, by inhibiting
the enzyme 14-a-demethylase, ultimately increases cellular
permeability and causes cell leakage. Some of these drugs
(e.g., ketoconazole) also interfere with human cortisol and
testosterone biosynthesis, which explains side effects such
as gynecomastia in men and menstrual irregularities in
women. Azoles are potent inhibitors of P450 hepatic metabolism
and have the potential to cause many severe and even
life-threatening drug interactions. Additionally, all azoles
have been associated with liver toxicity when used
systemically.

Voriconazole
Pharmacokinetics
Voriconazole is metabolized hepatically and inhibits P450
enzymes.
Clinical use
Voriconazole is an option for treating serious fungal infections
including those caused by Aspergillus and Scedosporium.
Adverse effects
Visual disturbances and hallucinations may occur; therefore
patients are warned not to drive at night. Some patients
experience a rash. Liver function test results may be elevated
and should be periodically monitored. Prolongation of the QT

interval on electrocardiograms may occur. Despite these side

effects, overall, voriconazole is better tolerated than amphotericin
B