CHAPTER 11: ANTI-FUNGAL AGENTS
o
FUNGUS
o Composed of a rigid cell wall made up of chitin
and various polysaccharides, and a cell
membrane containing ergosterol
o Protective layers of the fungal cell make the
organism resistant to antibiotics
PATIENTS SUSCEPTIBLE TO FUNGAL
INFECTIONS
o Patients with AIDS and AIDS-related
complex (ARC)
o Patients taking immunosuppressant drugs
o Patients who have undergone
transplantation surgery or cancer treatment
o Members of growing elderly population no
longer protected from environmental fungi
CULTURE
o A culture should be obtained prior to
prescribing anti-fungal agents.
o Patients on antifungal agents are typically
immunosuppressed and should not be
placed at additional risks for incorrect agent
and toxic effects.
MOST COMMON SYSTEMIC ANTIFUNGAL
AGENTS
o Caspofungin (Cancidas) (IV)
o Approved for the treatment of invasive
aspergillosis in patients who are
refractory to other treatments
o Flucytosine (Ancobon) (Oral)
o Less toxic drug used for the treatment
of systemic infections caused by
Candida or Cryptococcus
o Nystatin (Mycostatin, Nilstat) (Oral)
o Used for the treatment of intestinal
candidiasis; also available in a number
of topical preparations
AZOLES
o Indications - Newer class of drugs used to
treat systemic fungal infections, less toxic
than amphotericin B but also less effective,
bind to sterols and can cause cell death,
inhibit glucan synthesis
o Pharmacokinetics – Absorbed rapidly
from the GI tract, metabolized in the liver
and excreted in urine and feces
o Contraindications – Hepatic and renal
dysfunction, pregnancy and lactation and
drugs that prolong the QTc interval
o Adverse effect- Liver toxicity and
tetrogenic effects
o Drug-to–Drug Interaction- Many
ECHINOCANDIN ANTIFUNGALS
o Indications – Another group of antifungals,
inhibit glucan synthesis leading to death of
the cell wall
o Pharmacokinetics – Given IV, rapid
onset, metabolized degradation and
excreted in feces
o Contraindications – Hepatic /renal
dysfunction, pregnancy and lactation
Adverse effect- Liver toxicity, tetrogenic
effects and bone marrow supression
o Drug-to–Drug Interaction-
Cyclosporine
AMPHOTERICIN B
o Indications – Very potent – reserved for
progressive potential fatal fungal infections
o Pharmacokinetics - IV form only,
metabolism not well understood, excreted
in the urine
o Contraindications – Pregnancy, lactation
and renal impairment
o Adverse Effect - related to their toxic
effects on the liver and kidneys, severe
renal impairment and bone marrow
suppression
o Drug-to-drug Interaction- Nephrotoxic
antibiotics or antineoplastics, cyclosporine,
or corticosteroids
FLUCYTOSINE
o Indications – Prevent the fungal cells from
reproducing by altering the cell membrane
o Pharmacokinetics – IV form only,
metabolism not well understood, excreted
in the urine
o Contraindications – Pregnancy, lactation
and renal impairment
o Adverse Effect – Toxic effects on the
liver and kidneys and bone marrow
suppression
o Drug-to-drug Interaction- Nephrotoxic
antibiotics or antineoplastics, cyclosporine,
or corticosteroids
TOPICAL ANTIFUNGAL AGENTS
o Indication- Work to alter the cell
permeability of the fungus, causing
prevention of replication and fungal death,
indicated only for local treatment of
mycoses, including tinea infections
o Pharmacokinetics- Not systemic
o Contraindications- Limited to known
allergy to any of these drugs
o Adverse Reactions- Irritation, burning,
rash, and swelling at the site
o Drug-to-drug Interactions: Unknown
NURSING CONSIDERATIONS
1. SYSTEMIC
o Assess:
o History of allergy to antifungal
o Physical status
o Culture of the infected area
o Renal and hepatic function tests and
CBC
2. TOPICAL
o Assess:
o Known allergy to any topical antifungal
agent
o Physical status
o Culture and sensitivity testing
o Area of application for color,
temperature, and evidence of lesions

SITE OF ACTION OF ANTIFUNGALS