Effective antifungal drugs. Systemic antimycotics: a list of new generation antifungals Highly effective broad-spectrum antifungals

Antifungal drugs, or antimycotics, are a rather extensive class of various chemical compounds, both of natural origin and obtained by chemical synthesis, that have specific activity against pathogenic fungi. Depending on the chemical structure, they are divided into several groups that differ in their spectrum of activity, pharmacokinetics and clinical use in various fungal infections (mycoses).

Classification of antifungal drugs

Polyenes:

Nystatin

Natamycin

Amphotericin B

Amphotericin B liposomal

Azoles:

For systemic use

Ketoconazole

Fluconazole

Itraconazole

For topical application

clotrimazole

Miconazole

Bifonazole

Econazole

Isoconazole

Oxyconazole

Allylamines:

For systemic use

For topical application

Preparations of different groups:

For systemic use

Griseofulvin

Potassium iodide

For topical application

Amorolfine

Cyclopirox

The need for the use of antifungal drugs has recently increased significantly due to an increase in the prevalence of systemic mycoses, including severe life-threatening forms, which is primarily due to an increase in the number of patients with immunosuppression of various origins. More frequent invasive medical procedures and the (often unjustified) use of powerful, broad-spectrum AMPs are also important.

Polyena

Polyenes that are natural antimycotics include nystatin, levorin, and natamycin, which are applied topically and orally, as well as amphotericin B, which is used primarily for the treatment of severe systemic mycoses. Liposomal amphotericin B is one of the modern dosage forms of this polyene with improved tolerability. It is obtained by encapsulating amphotericin B in liposomes (fat vesicles formed when phospholipids are dispersed in water), which ensures the release of the active substance only upon contact with fungal cells and is intact with respect to normal tissues.

Mechanism of action

Polyenes, depending on the concentration, can have both fungistatic and fungicidal effects due to the binding of the drug to the ergosterol of the fungal membrane, which leads to a violation of its integrity, loss of cytoplasmic content and cell death.

Activity spectrum

Polyenes have the broadest spectrum of activity among antifungal drugs. in vitro.

When used systemically (amphotericin B), sensitive Candida spp. (among C. lusitaniae resistant strains are found). Aspergillus spp. ( A.terreus may be sustainable) C.neoformans, pathogens of mucomycosis ( Mucor spp., Rhizopus spp. and etc.), S.schenckii, causative agents of endemic mycoses ( B. dermatitidis, H. capsulatum, C.immitis, P. brasiliensis) and some other mushrooms.

However, when applied topically (nystatin, levorin, natamycin), they act mainly on Candida spp.

Polyenes are also active against some protozoa - Trichomonas (natamycin), Leishmania and Amoeba (amphotericin B).

Polyenes are resistant to dermatomycete fungi and pseudo-allescheria ( P. boydii).

Pharmacokinetics

All polyenes are practically not absorbed in the gastrointestinal tract and when applied topically. Amphotericin B when administered intravenously is distributed to many organs and tissues (lungs, liver, kidneys, adrenal glands, muscles, etc.), pleural, peritoneal, synovial and intraocular fluid. Poorly passes through the BBB. Slowly excreted by the kidneys, 40% of the administered dose is excreted within 7 days. The half-life is 24-48 hours, but with prolonged use it can increase up to 2 weeks due to cumulation in tissues. The pharmacokinetics of liposomal amphotericin B is generally less well understood. There is evidence that it creates higher peak blood concentrations than standard. It practically does not penetrate into the tissue of the kidneys (therefore, it is less nephrotoxic). It has more pronounced cumulative properties. The elimination half-life averages 4-6 days, with prolonged use, an increase up to 49 days is possible.

Adverse reactions

Nystatin, levorin, natamycin

(for systemic use)

Allergic reactions: rash, itching, Stevens-Johnson syndrome (rare).

(when applied topically)

Irritation of the skin and mucous membranes, accompanied by a burning sensation.

Amphotericin B

Reactions to IV infusion: fever, chills, nausea, vomiting, headache, hypotension. Preventive measures: premedication with the introduction of NSAIDs (paracetamol, ibuprofen) and antihistamines (diphenhydramine).

Local reactions: pain at the site of infusion, phlebitis, thrombophlebitis. Preventive measures: the introduction of heparin.

Kidneys: dysfunction - decreased diuresis or polyuria. Control measures: monitor clinical analysis of urine, determination of serum creatinine levels every other day during dose increase, and then at least twice a week. Preventive measures: hydration, exclusion of other nephrotoxic drugs.

Liver: possible hepatotoxic effect. Control measures: clinical and laboratory (transaminase activity) monitoring.

Electrolyte imbalances: hypokalemia, hypomagnesemia. Control measures: determination of the concentration of electrolytes in blood serum 2 times a week.

Hematological reactions: most often anemia, less often leukopenia, thrombocytopenia. Control measures: a clinical blood test with the determination of the number of platelets 1 time per week.

GIT: abdominal pain, anorexia, nausea, vomiting, diarrhea.

Nervous system: headache, dizziness, paresis, sensory disturbance, tremor, convulsions.

Allergic reactions: rash, itching, bronchospasm.

Amphotericin B liposomal

Compared to the standard drug, it rarely causes anemia, fever, chills, hypotension, and is less nephrotoxic.

Indications

Nystatin, levorin

Candida vulvovaginitis.

(Prophylactic use is ineffective!)

Natamycin

Candidiasis of the skin, oral cavity and pharynx, intestines.

Candida vulvovaginitis.

Candida balanoposthitis.

Trichomonas vulvovaginitis.

Amphotericin B

Severe forms of systemic mycoses:

invasive candidiasis,

aspergillosis,

cryptococcosis,

sporotrichosis,

mucormycosis,

trichosporosis,

fusarium,

pheogyphomycosis,

endemic mycoses (blastomycosis, coccidioidomycosis, paracoccidioidomycosis, histoplasmosis, penicilliosis).

Candidiasis of the skin and mucous membranes (locally).

Leishmaniasis.

Primary amoebic meningoencephalitis caused by N. fowleri.

Amphotericin B liposomal

Severe forms of systemic mycoses (see amphotericin B) in patients with renal insufficiency, with the ineffectiveness of the standard drug, with its nephrotoxicity, or severe reactions to IV infusion that cannot be stopped by premedication.

Contraindications

For all polyenes

Allergic reactions to drugs of the polyene group.

Additionally for amphotericin B

Liver dysfunction.

Kidney dysfunction.

Diabetes.

All contraindications are relative, since amphotericin B is almost always used for health reasons.

Warnings

Allergy. Data on cross-allergy to all polyenes are not available, however, in patients with an allergy to one of the polyenes, other drugs in this group should be used with caution.

Pregnancy. Amphotericin B passes through the placenta. Adequate and well-controlled studies on the safety of polyenes in humans have not been conducted. However, in numerous reports of the use of amphotericin B at all stages of pregnancy, adverse effects on the fetus have not been registered. Recommended to be used with caution.

Lactation. Data on the penetration of polyenes into breast milk are not available. No adverse effects have been noted in breastfed children. Recommended to be used with caution.

Pediatrics. No serious specific problems associated with the appointment of polyenes to children have been registered so far. In the treatment of oral candidiasis in children under 5 years of age, it is preferable to prescribe a suspension of natamycin, since buccal administration of nystatin or levorin tablets may be difficult.

Geriatrics. Due to possible changes in kidney function in the elderly, there may be an increased risk of amphotericin B nephrotoxicity.

Impaired kidney function. The risk of amphotericin B nephrotoxicity is significantly increased, so liposomal amphotericin B is preferred.

Impaired liver function. A higher risk of hepatotoxic action of amphotericin B is possible. It is necessary to compare the possible benefit from the use and the potential risk.

Diabetes. Since amphotericin B solutions (standard and liposomal) for intravenous infusion are prepared in 5% glucose solution, diabetes is a relative contraindication. It is necessary to compare the possible benefits of the application and the potential risk.

Drug Interactions

With the simultaneous use of amphotericin B with myelotoxic drugs (methotrexate, chloramphenicol, etc.), the risk of developing anemia and other hematopoietic disorders increases.

The combination of amphotericin B with nephrotoxic drugs (aminoglycosides, cyclosporine, etc.) increases the risk of severe renal dysfunction.

The combination of amphotericin B with non-potassium-sparing diuretics (thiazide, loop) and glucocorticoids increases the risk of developing hypokalemia, hypomagnesemia.

Amphotericin B, causing hypokalemia and hypomagnesemia, can increase the toxicity of cardiac glycosides.

Amphotericin B (standard and liposomal) is incompatible with 0.9% sodium chloride solution and other solutions containing electrolytes. When using systems for intravenous administration, established for the introduction of other drugs, it is necessary to flush the system with a 5% glucose solution.

Information for patients

When using nystatin, levorin and natamycin, strictly observe the regimen and treatment regimens during the entire course of therapy, do not skip a dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double the dose. Maintain the duration of therapy.

Observe the rules for storing drugs.

Azoles

Azoles are the most representative group of synthetic antimycotics, including drugs for systemic (ketoconazole, fluconazole, itraconazole) and local (bifonazole, isoconazole, clotrimazole, miconazole, oxiconazole, econazole) use. It should be noted that the first of the proposed "systemic" azoles - ketoconazole - after the introduction of itraconazole into clinical practice, has practically lost its significance due to high toxicity and has recently been more often used topically.

Mechanism of action

Azoles have a predominantly fungistatic effect, which is associated with inhibition of cytochrome P-450-dependent 14α-demethylase, which catalyzes the conversion of lanosterol to ergosterol, the main structural component of the fungal membrane. Local preparations, when creating high local concentrations in relation to a number of fungi, can act fungicidal.

Activity spectrum

Azoles have a wide spectrum of antifungal activity. The main causative agents of candidiasis are susceptible to itraconazole ( C. albicans, C. parapsilosis, C.tropicalis, C.lusitaniae and etc.), Aspergillus spp., Fusarium spp., C.neoformans, dermatomycetes ( Epidermophyton spp., Trichophyton spp., microsporum spp.), S. schenckii, P.boydii, H. capsulatum, B. dermatitidis, C.immitis, P. brasiliensis and some other mushrooms. Resistance is common in C.glabrata And C. krusei.

Ketoconazole is similar in spectrum to itraconazole, but does not affect Aspergillus spp.

Fluconazole is most active against most pathogens of candidiasis ( C. albicans, C. parapsilosis, C.tropicalis, C. lusitaniae etc.), cryptococcus and coccidioides, as well as dermatomycetes. Blastomycetes, histoplasmas, paracoccidioides and sporotrix are somewhat less sensitive to it. Does not work on aspergillus.

Azoles used topically are active mainly against Candida spp., dermatomycetes, M.furfur. They act on a number of other fungi that cause superficial mycoses. Some gram-positive cocci and corynebacteria are also sensitive to them. Clotrimazole is moderately active against some anaerobes (bacteroids, G.vaginalis) and Trichomonas.

Pharmacokinetics

Ketoconazole, fluconazole and itraconazole are well absorbed from the gastrointestinal tract. At the same time, for the absorption of ketoconazole and itraconazole, a sufficient level of acidity in the stomach is necessary, since, reacting with hydrochloric acid, they turn into highly soluble hydrochlorides. The bioavailability of itraconazole, administered in the form of capsules, is higher when taken with food, and in the form of a solution - on an empty stomach. Peak blood concentrations of fluconazole are reached after 1-2 hours, ketoconazole and itraconazole - after 2-4 hours.

Fluconazole is characterized by a low degree of plasma protein binding (11%), while ketoconazole and itraconazole are almost 99% protein bound.

Fluconazole and ketoconazole are relatively evenly distributed in the body, creating high concentrations in various organs, tissues and secretions. Fluconazole penetrates the BBB and the blood-brain barrier. CSF levels of fluconazole in patients with fungal meningitis range from 52% to 85% of plasma concentrations. Ketoconazole does not pass well through the BBB and creates very low concentrations in the CSF.

Itraconazole, being highly lipophilic, is distributed mainly to organs and tissues with a high fat content: liver, kidneys, and greater omentum. Able to accumulate in tissues that are particularly prone to fungal infection, such as the skin (including the epidermis), nail plates, lung tissue, genitalia, where its concentration is almost 7 times higher than in plasma. In inflammatory exudates, itraconazole levels are 3.5 times higher than plasma levels. At the same time, itraconazole practically does not penetrate into “aquatic” media - saliva, intraocular fluid, CSF.

Ketoconazole and itraconazole are metabolized in the liver, excreted mainly by the gastrointestinal tract. Itraconazole is partially excreted with the secretion of the sebaceous and sweat glands of the skin. Fluconazole is only partially metabolized, excreted by the kidneys mainly unchanged. The half-life of ketoconazole is 6-10 hours, itraconazole is 20-45 hours, does not change with renal failure. The half-life of fluconazole is 30 hours, with renal failure it can increase up to 3-4 days.

Itraconazole is not removed from the body during hemodialysis, the concentration of fluconazole in plasma during this procedure is reduced by 2 times.

Azoles for topical application create high and fairly stable concentrations in the epidermis and underlying affected skin layers, and the concentrations created exceed the MICs for the main fungi that cause skin mycoses. The longest lasting concentrations are characteristic of bifonazole, the half-life of which from the skin is 19-32 hours (depending on its density). Systemic absorption through the skin is minimal and has no clinical significance. With intravaginal application, absorption can be 3-10%.

Adverse reactions

Common to all systemic azoles

Gastrointestinal: abdominal pain, loss of appetite, nausea, vomiting, diarrhea, constipation.

CNS: headache, dizziness, drowsiness, visual disturbances, paresthesia, tremor, convulsions.

Allergic reactions: rash, itching, exfoliative dermatitis, Stevens-Johnson syndrome (more often when using fluconazole).

Hematological reactions: thrombocytopenia, agranulocytosis.

Liver: increased activity of transaminases, cholestatic jaundice.

Additionally for itraconazole

Cardiovascular system: congestive heart failure, arterial hypertension.

Liver: hepatotoxic reactions (rare)

Metabolic disorders: hypokalemia, edema.

Endocrine system: impaired production of corticosteroids.

Additionally for ketoconazole

Liver: severe hepatotoxic reactions, up to the development of hepatitis.

Endocrine system: impaired production of testosterone and corticosteroids, accompanied by gynecomastia, oligospermia, impotence in men, menstrual irregularities in women.

Common to local azoles

With intravaginal use: itching, burning, hyperemia and swelling of the mucous membrane, vaginal discharge, increased urination, pain during intercourse, burning sensation in the penis of the sexual partner.

Indications

Itraconazole

Pityriasis versicolor.

Candidiasis of the esophagus, skin and mucous membranes, nails, candidal paronychia, vulvovaginitis.

Cryptococcosis.

Aspergillosis (with resistance or poor tolerance to amphotericin B).

Pseudoallescheriosis.

Feogyphomycosis.

Chromomycosis.

Sporotrichosis.

endemic mycoses.

Prevention of mycoses in AIDS.

Fluconazole

invasive candidiasis.

Candidiasis of the skin, mucous membranes, esophagus, candidal paronychia, onychomycosis, vulvovaginitis.

Cryptococcosis.

Dermatomycosis: epidermophytosis, trichophytosis, microsporia.

Pityriasis versicolor.

Sporotrichosis.

Pseudoallescheriosis.

Trichosporosis.

Some endemic mycoses.

Ketoconazole

Candidiasis of the skin, esophagus, candidal paronychia, vulvovaginitis.

Pityriasis versicolor (systemically and locally).

Dermatomycosis (locally).

Seborrheic eczema (locally).

Paracoccidioidomycosis.

Azoles for topical use

Candidiasis of the skin, oral cavity and pharynx, vulvovaginal candidiasis.

Dermatomycosis: trichophytosis and epidermophytosis of smooth skin, hands and feet with limited lesions. With onychomycosis, they are ineffective.

Pityriasis versicolor.

Erythrasma.

Contraindications

Allergic reaction to drugs of the azole group.

Pregnancy (systemically).

Breastfeeding (systemically).

Severe liver dysfunction (ketoconazole, itraconazole).

Age up to 16 years (itraconazole).

Warnings

Allergy. Data on cross-allergy to all azoles are not available, however, in patients with an allergy to one of the azoles, other drugs in this group should be used with caution.

Pregnancy. Adequate studies of the safety of azoles in humans have not been conducted. Ketoconazole passes through the placenta. Fluconazole may interfere with estrogen synthesis. There is evidence of teratogenic and embryotoxic effects of azoles in animals. Systemic use in pregnant women is not recommended. Intravaginal use is not recommended in the first trimester, in others - no more than 7 days. For outdoor use, care should be taken.

Lactation. Azoles penetrate into breast milk, and fluconazole creates the highest concentrations in it, close to the level in blood plasma. The systemic use of azoles during breastfeeding is not recommended.

Pediatrics. Adequate safety studies of itraconazole in children under 16 years of age have not been conducted, so it is not recommended for use in this age group. In children, the risk of ketoconazole hepatotoxicity is higher than in adults.

Geriatrics. In the elderly, due to age-related changes in renal function, fluconazole excretion may be impaired, as a result of which a correction of the dosing regimen may be required.

H dysfunction of the kidneys. In patients with renal insufficiency, fluconazole excretion is impaired, which may be accompanied by its cumulation and toxic effects. Therefore, in case of renal insufficiency, a correction of the dosing regimen of fluconazole is required. Periodic monitoring of creatinine clearance is required.

Impaired liver function. Due to the fact that itraconazole and ketoconazole are metabolized in the liver, in patients with a violation of its function, their cumulation and the development of hepatotoxic effects are possible. Therefore, ketoconazole and itraconazole are contraindicated in such patients. When using these antimycotics, it is necessary to conduct regular clinical and laboratory monitoring (transaminase activity monthly), especially when ketoconazole is prescribed. Strict monitoring of liver function is also necessary in people suffering from alcoholism, or receiving other drugs that can adversely affect the liver.

Heart failure. Itraconazole may contribute to the progression of heart failure, so it should not be used for the treatment of skin fungal infections and onychomycosis in patients with impaired cardiac function.

Hypokalemia. When prescribing itraconazole, cases of hypokalemia, which was associated with the development of ventricular arrhythmias, are described. Therefore, with its long-term use, monitoring of the electrolyte balance is necessary.

Drug Interactions

Antacids, sucralfate, anticholinergics, H 2 blockers and proton pump inhibitors reduce the bioavailability of ketoconazole and itraconazole, as they reduce acidity in the stomach and disrupt the conversion of azoles into soluble forms.

Didanosine (containing a buffer medium necessary to increase gastric pH and improve drug absorption) also reduces the bioavailability of ketoconazole and itraconazole.

Ketoconazole, itraconazole and, to a lesser extent, fluconazole are inhibitors of cytochrome P-450, therefore, they can interfere with the metabolism of the following drugs in the liver:

oral antidiabetic (chlorpropamide, glipizide, etc.), the result may be hypoglycemia. Strict control of blood glucose is required, with possible adjustment of the dosage of antidiabetic drugs;

indirect anticoagulants of the coumarin group (warfarin, etc.), which may be accompanied by hypocoagulation and bleeding. Laboratory monitoring of hemostasis parameters is required;

cyclosporine, digoxin (ketoconazole and itraconazole), theophylline (fluconazole), which can lead to an increase in their concentration in the blood and toxic effects. Clinical control, monitoring of drug concentrations with possible correction of their dosage is necessary. There are recommendations to reduce the dose of cyclosporine by 2 times since the concomitant appointment of itraconazole;

terfenadine, astemizole, cisapride, quinidine, pimozide. An increase in their concentration in the blood may be accompanied by a prolongation of the QT interval on the ECG with the development of severe, potentially fatal ventricular arrhythmias. Therefore, combinations of azoles with these drugs are unacceptable.

The combination of itraconazole with lovastatin or simvastatin is accompanied by an increase in their concentration in the blood and the development of rhabdomyolysis. During treatment with itraconazole, statins should be discontinued.

Rifampicin and isoniazid increase the metabolism of azoles in the liver and lower their plasma concentrations, which may be the cause of treatment failure. Therefore, azoles are not recommended for use in combination with rifampicin or isoniazid.

Carbamazepine reduces the concentration of itraconazole in the blood, which may be the reason for the ineffectiveness of the latter.

Cytochrome P-450 inhibitors (cimetidine, erythromycin, clarithromycin, etc.) can block the metabolism of ketoconazole and itraconazole and increase their blood concentrations. The simultaneous use of erythromycin and itraconazole is not recommended due to the possible development of cardiotoxicity of the latter.

Ketoconazole interferes with alcohol metabolism and can cause disulfirap-like reactions.

Information for patients

Azole preparations, when taken orally, should be washed down with a sufficient amount of water. Ketoconazole and itraconazole capsules should be taken with or immediately after a meal. With low acidity in the stomach, these drugs are recommended to be taken with drinks that have an acidic reaction (for example, cola). It is necessary to observe intervals of at least 2 hours between taking these azoles and drugs that lower acidity (antacids, sucralfate, anticholinergics, H 2 blockers, proton pump inhibitors).

During treatment with systemic azoles, terfenadine, astemizole, cisapride, pimozide, quinidine should not be taken. In the treatment of itraconazole - lovastatin and simvastatin.

Strictly observe the regimen and treatment regimens during the entire course of therapy, do not skip the dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double the dose. Maintain the duration of therapy.

Do not use drugs that have expired.

Do not use azoles systemically during pregnancy and lactation. Intravaginal use of azoles is contraindicated in the first trimester of pregnancy, in others - no more than 7 days. When treating with systemic azoles, reliable methods of contraception should be used.

Before starting the intravaginal use of azoles, carefully study the instructions for use of the drug. During pregnancy, discuss with your doctor the possibility of using the applicator. Use only special swabs. Observe the rules of personal hygiene. It should be borne in mind that some intravaginal forms may contain ingredients that damage the latex. Therefore, you should refrain from using latex barrier contraceptives during treatment and for 3 days after its completion.

In the treatment of mycoses of the feet, it is necessary to carry out antifungal treatment of shoes, socks and stockings.

Allylamines

Allylamines, which are synthetic antimycotics, include terbinafine, applied orally and topically, and naftifine, intended for topical use. The main indications for the use of allylamines are dermatomycosis.

Mechanism of action

Allylamines have a predominantly fungicidal effect associated with a violation of the synthesis of ergosterol. Unlike azoles, allylamines block earlier stages of biosynthesis by inhibiting the enzyme squalene epoxidase.

Activity spectrum

Allylamines have a wide spectrum of antifungal activity. Dermatomycetes are sensitive to them ( Epidermophyton spp., Trichophyton spp., micro-sporum spp.), M.furfur, candida, aspergillus, histoplasma, blastomycetes, cryptococcus, sporotrix, causative agents of chromomycosis.

Terbinafine active in vitro also against a number of protozoa (some varieties of leishmania and trypanosomes).

Despite the wide spectrum of activity of allylamines, only their effect on causative agents of dermatomycosis is of clinical importance.

Pharmacokinetics

Terbinafine is well absorbed from the gastrointestinal tract, and bioavailability is practically independent of food intake. Almost completely (99%) binds to plasma proteins. Having a high lipophilicity, terbinafine is distributed into many tissues. Diffusing through the skin, as well as standing out with the secrets of the sebaceous and sweat glands, it creates high concentrations in the stratum corneum of the epidermis, nail plates, hair follicles, and hair. Metabolized in the liver, excreted by the kidneys. The half-life is 11-17 hours, increases with renal and hepatic insufficiency.

When applied topically, systemic absorption of terbinafine is less than 5%, of naftifine - 4-6%. The preparations create high concentrations in various layers of the skin, exceeding the MIC for the main pathogens of dermatomycosis. The absorbed portion of naftifine is partially metabolized in the liver, excreted in the urine and feces. The half-life is 2-3 days.

Adverse reactions

Terbinafine inside

Gastrointestinal: abdominal pain, loss of appetite, nausea, vomiting, diarrhea, changes and loss of taste.

CNS: headache, dizziness.

Allergic reactions: rash, urticaria, exfoliative dermatitis, Stevens-Johnson syndrome.

Hematological reactions: neutropenia, pancytopenia.

Liver: increased activity of transaminases, cholestatic jaundice, liver failure.

Other: arthralgia, myalgia.

Terbinafine topically, naftifine

Skin: itching, burning, hyperemia, dryness.

Indications

Dermatomycosis: epidermophytosis, trichophytosis, microsporia (with limited damage - locally, with widespread - inside).

Mycosis of the scalp (inside).

Onychomycosis (inside).

Chromomycosis (inside).

Skin candidiasis (locally).

Pityriasis versicolor (locally).

Contraindications

Allergic reaction to drugs of the allylamine group.

Pregnancy.

Lactation.

Age up to 2 years.

Warnings

Allergy. Data on cross-allergy to terbinafine and naftifine are not available, however, in patients with an allergy to one of the drugs, the other should be used with caution.

Pregnancy. Adequate safety studies of allylamines have not been conducted. Use in pregnant women is not recommended.

Lactation. Terbinafine passes into breast milk. Use in breastfeeding women is not recommended.

Pediatrics. Adequate safety studies in children under 2 years of age have not been conducted, so use in this age group is not recommended.

Geriatrics. In the elderly, due to age-related changes in renal function, terbinafine excretion may be impaired, as a result of which a correction of the dosing regimen may be required.

Impaired kidney function. In patients with renal insufficiency, the excretion of terbinafine is impaired, which may be accompanied by its cumulation and toxic effects. Therefore, in case of renal insufficiency, a correction of the terbinafine dosing regimen is required. Periodic monitoring of creatinine clearance is necessary.

Impaired liver function. Possible increased risk of terbinafine hepatotoxicity. Adequate clinical and laboratory monitoring is required. With the development of severe liver dysfunction during treatment with terbinafine, the drug should be discontinued. Strict monitoring of liver function is necessary in alcoholism and in people receiving other drugs that can adversely affect the liver.

Drug Interactions

Inducers of microsomal liver enzymes (rifampicin, etc.) can increase the metabolism of terbinafine and increase its clearance.

Inhibitors of microsomal liver enzymes (cimetidine, etc.) can block the metabolism of terbinafine and reduce its clearance.

In the situations described, it may be necessary to adjust the dosing regimen of terbinafine.

Information for patients

Terbinafine can be taken orally regardless of food intake (on an empty stomach or after a meal), should be washed down with a sufficient amount of water.

Do not drink alcoholic beverages during treatment.

Do not use drugs that have expired.

Do not use allylamines during pregnancy and lactation.

Do not allow topical preparations to come into contact with the mucous membrane of the eyes, nose, mouth, open wounds.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Preparations of different groups

Griseofulvin

One of the earliest natural antimycotics with a narrow spectrum of activity. It is produced by a fungus of the genus Penicillium. It is used only for dermatomycosis caused by dermatomycete fungi.

Mechanism of action

It has a fungistatic effect, which is due to the inhibition of the mitotic activity of fungal cells in the metaphase and the disruption of DNA synthesis. Selectively accumulating in the "prokeratin" cells of the skin, hair, nails, griseofulvin gives the newly formed keratin resistance to fungal infection. The cure occurs after the complete replacement of the infected keratin, so the clinical effect develops slowly.

Activity spectrum

Dermatomycetes are sensitive to griseofulvin ( Epidermophyton spp., Trichophyton spp., microsporum spp.). Other mushrooms are resistant.

Pharmacokinetics

Griseofulvin is well absorbed from the gastrointestinal tract. Bioavailability is increased when taken with fatty foods. The maximum concentration in the blood is noted after 4 hours. High concentrations are created in the keratin layers of the skin, hair, nails. Only a small part of griseofulvin is distributed to other tissues and secretions. Metabolized in the liver. Excreted with feces (36% in active form) and urine (less than 1%). The half-life is 15-20 hours, does not change with renal failure.

Adverse reactions

Gastrointestinal: abdominal pain, nausea, vomiting, diarrhea.

Nervous system: headache, dizziness, insomnia, peripheral neuritis.

Skin: rash, itching, photodermatitis.

Hematological reactions: granulocytopenia, leukopenia.

Liver: increased activity of transaminases, jaundice, hepatitis.

Other: oral candidiasis, lupus-like syndrome.

Indications

Dermatomycosis: epidermophytosis, trichophytosis, microsporia.

Mycosis of the scalp.

Onychomycosis.

Contraindications

Allergic reaction to griseofulvin.

Pregnancy.

Liver dysfunction.

Systemic lupus erythematosus.

Porfiry.

Warnings

Pregnancy. Griseofulvin crosses the placenta. Adequate safety studies in humans have not been conducted. There is evidence of teratogenic and embryotoxic effects in animals. Use in pregnant women is not recommended.

Lactation.

Geriatrics. In the elderly, due to age-related changes in liver function, the risk of hepatotoxicity of griseofulvin may be increased. Strict clinical and laboratory control is required.

Impaired liver function. Due to the hepatotoxicity of griseofulvin, its administration requires regular clinical and laboratory monitoring. In case of impaired liver function, it is not recommended to prescribe. Strict monitoring of liver function is also necessary in alcoholism and in people receiving other drugs that can adversely affect the liver.

Drug Interactions

Inducers of microsomal liver enzymes (barbiturates, rifampicin, etc.) can increase the metabolism of griseofulvin and weaken its effect.

Griseofulvin induces cytochrome P-450, therefore, it can increase metabolism in the liver and, therefore, weaken the effect of:

indirect anticoagulants of the coumarin group (control of prothrombin time is necessary, dose adjustment of the anticoagulant may be required);

oral antidiabetic drugs, (blood glucose control with possible dose adjustment of antidiabetic drugs);

theophylline (monitoring of its concentration in the blood with possible dose adjustment);

Griseofulvin enhances the effect of alcohol.

Information for patients

Griseofulvin should be taken orally during or immediately after a meal. If a low-fat diet is used, griseofulvin should be taken with 1 tablespoon of vegetable oil.

Do not drink alcoholic beverages during treatment.

Strictly observe the regimen and treatment regimens during the entire course of therapy, do not skip the dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double the dose.

Do not use drugs that have expired.

Be careful with dizziness.

Do not expose to direct insolation.

Do not use griseofulvin during pregnancy and lactation.

During treatment with griseofulvin and within 1 month after the end, do not use only estrogen-containing oral preparations for contraception. Be sure to use additional or alternative methods.

In the treatment of mycoses of the feet, it is necessary to carry out antifungal treatment of shoes, socks and stockings.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Potassium iodide

As an antifungal drug, potassium iodide is used orally as a concentrated solution (1.0 g/ml). The mechanism of action is not exactly known.

Activity spectrum

Active against many fungi, but the main clinical significance is the effect on S.schenckii.

Pharmacokinetics

Quickly and almost completely absorbed in the gastrointestinal tract. It is distributed mainly in the thyroid gland. It also accumulates in the salivary glands, gastric mucosa, and mammary glands. Concentrations in saliva, gastric juice and breast milk are 30 times higher than in blood plasma. Excreted mainly by the kidneys.

Adverse reactions

Gastrointestinal: abdominal pain, nausea, vomiting, diarrhea.

Endocrine system: changes in thyroid function (requires appropriate clinical and laboratory monitoring).

Reactions of iodism: rash, rhinitis, conjunctivitis, stomatitis, laryngitis, bronchitis.

Others: lymphadenopathy, swelling of the submandibular salivary glands.

With the development of severe HP should reduce the dose or temporarily stop taking. After 1-2 weeks, treatment can be resumed at lower doses.

Indications

Sporotrichosis: cutaneous, cutaneous-lymphatic.

Contraindications

Hypersensitivity to iodine preparations.

Hyperthyroidism.

Tumors of the thyroid gland.

Warnings

Pregnancy. Adequate safety studies have not been conducted. Use in pregnant women is possible only in cases where the intended benefit outweighs the risk.

Lactation. Concentrations of potassium iodide in breast milk are 30 times higher than in plasma. During treatment, breastfeeding should be discontinued.

Drug Interactions

When combined with potassium preparations or potassium-sparing diuretics, hyperkalemia may develop.

Information for patients

Potassium iodide should be taken orally after meals. A single dose is recommended to be diluted with water, milk or fruit juice.

Strictly observe the regimen and treatment regimens during the entire course of therapy, do not skip the dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double the dose. Maintain the duration of therapy. Irregular use or premature termination of treatment increases the risk of relapse.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Amorolfine

Synthetic antimycotic agent for topical use (in the form of nail polish), which is a derivative of morpholine.

Mechanism of action

Depending on the concentration, it can have both fungistatic and fungicidal effects due to a violation of the structure of the cell membrane of fungi.

Activity spectrum

It is characterized by a wide spectrum of antifungal activity. sensitive to him Candida spp., dermatomycetes, Pityrosporum spp., Cryptococcus spp. and a number of other mushrooms.

Pharmacokinetics

When applied topically, it penetrates well into the nail plate and nail bed. Systemic absorption is insignificant and has no clinical significance.

Adverse reactions

Local: burning, itching or irritation of the skin around the nail, discoloration of the nails (rarely).

Indications

Onychomycosis caused by dermatomycetes, yeasts and molds (if no more than 2/3 of the nail plate is affected).

Prevention of onychomycosis.

Contraindications

Hypersensitivity to amorolfine.

Pregnancy.

Lactation.

Age up to 6 years.

Warnings

Pregnancy.

Lactation. Adequate safety data are not available. Use during breastfeeding is not recommended.

Pediatrics.

Drug Interactions

Systemic antimycotics enhance the therapeutic effect of amorolfine.

Information for patients

Carefully study the instructions for use.

Maintain the duration of therapy. Irregular use or premature termination of treatment increases the risk of relapse.

All altered nail tissue should be regularly ground down. Files used on diseased nails should not be used on healthy nails.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Observe storage rules.

Cyclopirox

Synthetic antifungal drug for topical use with a wide spectrum of activity. The mechanism of action has not been established.

Activity spectrum

sensitive to ciclopirox Candida spp., dermatomycetes, M.furfur, Cladosporium spp. and many other mushrooms. It also acts on some gram-positive and gram-negative bacteria, mycoplasmas and Trichomonas, but this is of no practical importance.

Pharmacokinetics

When applied topically, it quickly penetrates into various layers of the skin and its appendages, creating high local concentrations that are 20–30 times higher than the MIC for the main pathogens of superficial mycoses. When applied to large areas, it can be slightly absorbed (1.3% of the dose is found in the blood), 94–97% binds to plasma proteins, and is excreted by the kidneys. The half-life is 1.7 hours.

Adverse reactions

Local: burning, itching, irritation, peeling or flushing of the skin.

Indications

Dermatomycosis caused by dermatomycetes, yeasts and molds.

Onychomycosis (if no more than 2/3 of the nail plate is affected).

Fungal vaginitis and vulvovaginitis.

Prevention of fungal infections of the feet (powder in socks and / or shoes).

Contraindications

Hypersensitivity to ciclopirox.

Pregnancy.

Lactation.

Age up to 6 years.

Warnings

Pregnancy. Adequate safety studies have not been conducted. Use in pregnant women is not recommended.

Lactation. Adequate safety data are not available. Use during breastfeeding is not recommended.

Pediatrics. Adequate safety studies have not been conducted. Use in children under 6 years of age is not recommended.

Drug Interactions

Systemic antimycotics enhance the therapeutic effect of ciclopirox.

Information for patients

Carefully study the instructions for use of the prescribed dosage form of the drug.

Strictly observe the regimen and treatment regimens during the entire course of therapy.

Maintain the duration of therapy. Irregular use or premature termination of treatment increases the risk of relapse.

Protective impervious gloves must be worn when working with organic solvents.

In the treatment of onychomycosis, all altered nail tissue should be regularly ground down. Files used on affected nails should not be used on healthy nails.

Avoid getting the solution and cream in the eyes.

The vaginal cream must be inserted deep into the vagina using the supplied disposable applicators, preferably at night. A new applicator is used for each procedure.

Consult a doctor if improvement does not occur at the time indicated by the doctor or if new symptoms appear.

Observe storage rules.

Table. Antifungal drugs.
Main characteristics and application features

INN	Lekform LS	F (inside), %	T ½, h *	Dosing regimen	Features of drugs
Polyena
Amphotericin B	Since. d/inf. 0.05 g in vial. Ointment 3% in tubes of 15 g and 30 g	-	24–48	I/V Adults and children: test dose of 1 mg in 20 ml of 5% glucose solution for 1 hour; therapeutic dose 0.3–1.5 mg/kg/day Rules for the introduction of a therapeutic dose: diluted in 400 ml of 5% glucose solution, administered at a rate of 0.2–0.4 mg / kg / h locally The ointment is applied to the affected areas of the skin 1-2 times a day.	It has a wide spectrum of antifungal activity, but is highly toxic. It is used in/in with severe systemic mycoses. The duration of treatment depends on the type of mycosis. To prevent infusion reactions, premedication is carried out using NSAIDs and antihistamines. Enter only on glucose! Topically used for candidiasis of the skin
Amphotericin B liposomal	Since. d/inf. 0.05 g in vial.	-	4–6 days	I/V Adults and children: 1–5 mg/kg/day	It is better tolerated than amphotericin B. It is used in patients with renal insufficiency, with the ineffectiveness of the standard drug, its nephrotoxicity, or infusion reactions that cannot be stopped by premedication. Enter only on glucose!
Nystatin	Tab. 250 thousand units and 500 thousand units Tab. vagina. 100 thousand units Ointment 100 thousand units / g	-	ND	inside Adults: 500,000–1 million units every 6 hours for 7–14 days; with candidiasis of the oral cavity and pharynx, dissolve in 1 table. every 6-8 hours after meals Children: 125-250 thousand units every 6 hours for 7-14 days intravaginally 1-2 tables. vagina. overnight for 7-14 days locally	Only works on mushrooms Candida Practically not absorbed in the gastrointestinal tract, acts only with local contact Indications: candidiasis of the skin, oral cavity and pharynx, intestines, vulvovaginal candidiasis
Levorin	Tab. 500 thousand units Tab. slap 500 thousand units Tab. vagina. 250 thousand units Ointment 500 thousand units / g	-	ND	inside Adults: 500 thousand units every 8 hours for 7-14 days; with candidiasis of the oral cavity and pharynx, dissolve in 1 table. slap every 8-12 hours after meals Children: up to 6 years - 20-25 thousand units / kg every 8-12 hours for 7-14 days; older than 6 years - 250 thousand units every 8-12 hours for 7-14 days intravaginally 1-2 tables. overnight for 7-14 days locally The ointment is applied to the affected areas of the skin 2 times a day.	Similar in action and application to nystatin
Natamycin	Tab. 0.1 g Susp. 2.5% in vial. 20 ml Vagina candles. 0.1 g Cream 2% in tubes of 30 g	-	ND	inside Adults: 0.1 g every 6 hours for 7 days Children: 0.1 g every 12 hours for 7 days With candidiasis of the oral cavity and pharynx, adults and children are applied to the affected areas with 0.5–1 ml of susp. every 4-6 hours intravaginally 1 suppository at night for 3-6 days locally The cream is applied to the affected areas of the skin 1-3 times a day.	Compared with nystatin and levorin, it has a slightly wider spectrum of activity. Similar indications
Azoles
Itraconazole	Caps. 0.1 g Solution for oral administration 10 mg / ml in a vial. 150 ml	Caps. 40-55 (on an empty stomach) 90-100 (with food) Solution 90-100 (on an empty stomach) 55 (with food)	20–45	inside Adults: 0.1-0.6 g every 12-24 hours, the dose and duration of the course depends on the type of infection; with vulvovaginal candidiasis - 0.2 g every 12 hours one day or 0.2 g / day for 3 days	It has a wide spectrum of activity and fairly good tolerance. Indications: aspergillosis, sporotrichosis, candidiasis of the esophagus, skin and its appendages, mucous membranes, vulvovaginal candidiasis, ringworm, pityriasis versicolor. Interacts with many drugs. Caps. should be taken during or immediately after a meal, rr - 1 hour or 2 hours after a meal
Fluconazole	Caps. 0.05 g, 0.1 g, 0.15 g Since. for susp. d / ingestion of 10 mg / ml and 40 mg / ml in a vial. 50 ml Solution for inf. 2 mg/ml in vial. 50 ml	90	30	inside Adults: 0.1-0.6 g / day in 1 dose, the duration of the course depends on the type of infection; with sporotrichosis and pseudoalescheriasis - up to 0.8–0.12 g / day; with candidal onychomycosis and paronychia - 0.15 g once a week; with pityriasis versicolor - 0.4 g once; with vulvovaginal candidiasis 0.15 g once Children: with candidiasis of the skin and mucous membranes - 1-2 mg / kg / day in 1 dose; with systemic candidiasis and cryptococcosis - 6-12 mg / kg / day in 1 dose I/V Adults: 0.1-0.6 g / day in 1 injection; with sporotrichosis and pseudoalescheriosis - up to 0.8–0.12 g / day Children: with candidiasis of the skin and mucous membranes - 1-2 mg / kg / day in 1 injection; with systemic candidiasis and cryptococcosis - 6-12 mg / kg / day in 1 injection In / in administered by slow infusion at a rate of not more than 10 ml / min	Most active in relation to candida spp., cryptococcus, dermatomycetes. The drug of choice for the treatment of candidiasis. It penetrates well through the BBB, high concentration in the CSF and urine. Very well tolerated. Inhibits cytochrome P-450 (weaker than itraconazole)
Ketoconazole	Tab. 0.2 g Cream 2% in tubes of 15 g Shampoo. 2% in vial. 25 ml and 60 ml each	75	6–10	inside Adults: 0.2-0.4 g / day in 2 doses, the duration of the course depends on the type of infection. locally The cream is applied to the affected areas of the skin 1-2 times a day for 2-4 weeks. Shampoo. used for seborrheic eczema and dandruff - 2 times a week for 3-4 weeks, for pityriasis versicolor - daily for 5 days (applied to the affected areas for 3-5 minutes, then washed off with water)	Apply inside or topically. Does not penetrate the BBB. It has a wide spectrum of activity, but systemic use is limited due to hepatotoxicity. Can cause hormonal disorders, interacts with many drugs. Locally used for pityriasis versicolor, ringworm, seborrheic eczema. Inside should be taken during or immediately after a meal
clotrimazole	Tab. vagina. 0.1 g Cream 1% in tubes of 20 g	3–10 **	ND	intravaginally Adults: 0.1 g at night for 7–14 days locally Cream and solution are applied to the affected areas of the skin with light rubbing 2-3 times a day. With candidiasis of the oral cavity and pharynx - treat the affected areas with 1 ml r-ra 4 times a day	Basic imidazole for topical use. Indications: candidiasis of the skin, oral cavity and pharynx, vulvovaginal candidiasis, ringworm, pityriasis versicolor, erythrasma
Bifonazole	Cream 1% in tubes of 15 g, 20 g and 35 g Cream 1% in the set for the treatment of nails Solution for nar. 1% in vial. 15 ml	2–4 ***	ND	locally The cream and solution are applied to the affected areas of the skin with light rubbing once a day (preferably at night). In case of onychomycosis, after applying the cream, close the nails with a plaster and a bandage for 24 hours, after removing the bandage, dip the fingers in warm water for 10 minutes, then remove the softened nail tissue with a scraper, dry the nail and reapply the cream and apply the patch. The procedures are carried out for 7-14 days (until the nail bed becomes smooth and the entire affected part is removed)	Indications: skin candidiasis, ringworm, onychomycosis (with limited lesions), pityriasis versicolor, erythrasma
Econazole	Cream 1% in tubes of 10 g and 30 g Aeroz. 1% in vial. 50 g each Vagina candles. 0.15 g	-	ND	locally The cream is applied to the affected areas of the skin and gently rubbed, 2 times a day. Aeroz. spray from a distance of 10 cm on the affected areas of the skin and rub until completely absorbed, 2 times a day intravaginally
Isoconazole	Vagina candles. 0.6 g	-	ND	locally The cream is applied to the affected areas of the skin 1 time per day for 4 weeks. intravaginally 1 suppository at night for 3 days	Indications: skin candidiasis, vulvovaginal candidiasis, ringworm
Oxyconazole	Cream 1% in tubes of 30 g	-	ND	locally The cream is applied to the affected areas of the skin 1 time per day for 2-4 weeks.	Indications: skin candidiasis, ringworm
Allylamines
Terbinafine	Tab. 0.125 g and 0.25 g Cream 1% in tubes of 15 g Spray 1% in a bottle. 30 ml	80 (inside) less than 5 (locally)	11–17	inside Adults: 0.25 g/day in 1 dose Children over 2 years old: body weight up to 20 kg - 62.5 mg / day, 20-40 kg - 0.125 g / day, more than 40 kg - 0.25 g / day, in 1 dose The duration of the course depends on the location of the lesion. locally Cream or spray is applied to the affected areas of the skin 1-2 times a day for 1-2 weeks.	Indications: ringworm, mycosis of the scalp, onychomycosis, chromomycosis, skin candidiasis, pityriasis versicolor
Naftifin	Cream 1% in tubes of 1 g and 30 g Solution 1% in a bottle. 10 ml	4–6 (local)	2–3 days	locally Cream or solution is applied to the affected areas of the skin 1 time per day for 2-8 weeks	Indications: skin candidiasis, ringworm, pityriasis versicolor
Drugs of other groups
Griseofulvin	Tab. 0.125 g and 0.5 g Susp. d / ingestion 125 mg / 5 ml in a vial.	70–90	15–20	inside Adults: 0.25–0.5 g every 12 hours Children: 10 mg/kg/day in 1-2 doses	One of the oldest antimycotics for systemic use. Reserve drug for dermatomycosis. In severe lesions, it is inferior in effectiveness to systemic azoles and terbinafine. Induces cytochrome P-450. Enhances the effects of alcohol
Potassium iodide	Since. (used as a solution of 1 g/ml)	90–95	ND	inside Adults and children: the initial dose is 5 drops. every 8-12 hours, then a single dose is increased by 5 drops. per week and bring up to 25-40 cap. every 8-12 hours Course duration - 2–4 months	Indication: skin and skin-lymphatic spore-trichosis. May cause "iodism" reactions and changes in thyroid function. It is excreted in large quantities with breast milk, so breastfeeding should be stopped during treatment.
Amorolfine	Lacquer for nails 5% in a bottle. 2.5 ml each (complete with tampons, spatulas and nail files)	-	ND	locally Lacquer is applied to the affected nails 1-2 times a week. Periodically remove the affected nail tissue	Indications: onychomycosis caused by dermatomycetes, yeasts and molds (if no more than 2/3 of the nail plate is affected); prevention of onychomycosis
Cyclopirox	Cream 1% in tubes of 20 g and 50 g Solution 1% in a bottle. 20 ml and 50 ml each Vagina cream. 1% in tubes of 40 g Powder 1% in a bottle. 30 g each	1.3 (local)	1,7	locally Cream or solution is applied to the affected areas of the skin and gently rubbed 2 times a day for 1-2 weeks The powder is periodically poured into shoes, socks or stockings intravaginally The cream is administered with the included applicator at night for 1-2 weeks	Indications: ringworm, onychomycosis (if no more than 2/3 of the nail plate is affected), fungal vaginitis and vulvovaginitis; prevention of fungal infections of the feet. Not recommended for use in children under 6 years of age
Combined drugs
Nystatin/ ternidazole/ neomycin/ prednisolone	Tab. vagina. 100 thousand units + 0.2 g + 0.1 g + 3 mg	ND	ND	intravaginally Adults: 1 tab. overnight for 10-20 days	The drug has an antifungal, antibacterial, antiprotozoal, and anti-inflammatory effect. Indications: vaginitis of candidal, bacterial, Trichomonas and mixed etiology
Nystatin/ neomycin/ polymyxin B	Caps. vagina. 100 thousand units + 35 thousand units + 35 thousand units	ND	ND	intravaginally Adults: 1 caps. overnight for 12 days	The drug combines antifungal and antibacterial action. Indications: vaginitis of candidal, bacterial and mixed etiology
Natamycin/ neomycin/ hydrocortisone	Cream, ointment 10 mg + 3.5 mg + 10 mg per 1 g in tubes of 15 g Lotion 10 mg + 1.75 mg + 10 mg per 1 g vial. 20 ml	-/ 1–5/ 1–3 (locally)	ND	locally Apply to the affected areas of the skin 2-4 times a day for 2-4 weeks	The drug has an antibacterial, antifungal and anti-inflammatory effect. Indications: skin infections of fungal and bacterial etiology with a pronounced inflammatory component
Clotrimazole / gentamicin/ betamethasone	Cream, ointment 10 mg + 1 mg + 0.5 mg per 1 g in tubes of 15 g	ND	ND	locally Apply to the affected areas of the skin 2 times a day for 2-4 weeks	Same
Miconazole / metronidazole	Tab. vag. 0.1 g + 0.1 g	-/ 50 (locally)	-/ 8	intravaginally Adults: 1 tab. overnight for 7-10 days	The drug combines antifungal and antiprotozoal activity. Indications: vaginitis of candidal and trichomonas etiology

* With normal kidney function

** With intravaginal administration. When applied externally, it is practically not absorbed

*** When applied to inflamed skin

Fungal skin lesions are considered fairly common infectious diseases. To achieve complete recovery, it is necessary to prescribe specific antifungal therapy. In this article, we will consider the most commonly used drugs (antimycotics) for the treatment of skin diseases of a fungal nature.

Varieties of antifungal drugs

According to the mechanism of action, antimycotics are divided into fungicidal and fungistatic. In the first case, the drugs destroy the fungi, in the second, they prevent the emergence of new ones. In addition, based on the chemical structure, antifungal agents are conventionally divided into five groups:

• Polyenes (for example, Nystatin).
• Azoles (Flucanazole, Clotrimazole).
• Allylamines (Naftifin, Terbinafine).
• Morpholines (Amorolfine).
• Drugs with antifungal activity, but from different chemical subgroups (Flucytosine, Griseofulvin).

Antimycotic action is the pharmacological property of a drug to destroy or stop the emergence of new pathogenic fungi in the human body.

Systemic antimycotic drugs

To date, systemic antimycotic agents for oral administration, which are highly effective, are represented by the following drugs:

• Griseofulvin.
• Ketoconazole.
• Terbinafine.
• Itraconazole.
• Fluconazole.

Systemic antifungal therapy is indicated for patients who have a widespread or deep mycotic process, as well as damage to the hair and nails. The expediency of prescribing certain drugs or methods of treatment is determined by the attending doctor, taking into account the nature of the pathological changes and the current state of the patient.

Griseofulvin

The antifungal agent Griseofulvin has a fungistatic effect on all dermophytes included in the genera Trichophyton, Microsporum, Achorion and Epidermophyton. At the same time, it will not be possible to stop the reproduction of yeast-like and mold fungi with this drug. The success of therapy largely depends on the correct daily and course dosage of Griseofulvin. It should be noted that the average duration of therapy is about six months. However, some patients may be prescribed longer courses.

The antimycotic drug Griseofulfin is indicated in the presence of:

• Dermatophytosis.
• Mycoses of the feet, nails, torso, etc.
• Microsporia of smooth skin and scalp.
• Various clinical forms of epidermophytosis.

However, I would like to note that this antifungal agent is not used during periods of pregnancy and breastfeeding. In addition, it is contraindicated in:

• Allergy to the active substance of the drug.
• Porfiria.
• Blood diseases.
• Systemic lupus erythematosus.
• Severe disorders of the liver and / or kidneys.
• Malignant tumors.
• Uterine bleeding.
• Post-stroke states.

It has been clinically established that Griseofulvin leads to an increase in the action of ethanol. Reduces the effectiveness of contraceptives that contain estrogen. With simultaneous use with barbiturates or Primidone, antifungal efficacy decreases. During the therapeutic course, periodically (every 2 weeks) check the main blood parameters and the functional state of the liver. The drug is available in tablets and is sold at a price of 220 rubles.

Itraconazole

Antifungal drugs with a wide range of effects include Itraconazole. Assigned to the group of triazole derivatives. Dermatophytes, yeast-like and mold fungi are sensitive to the action of this drug. It is indicated for infectious diseases that are caused by the above pathogenic and opportunistic microorganisms. It is prescribed in case of diagnosis:

• Mycosis of the skin and mucous membranes.
• Onychomycosis.
• Candidal lesion.
• Pityriasis versicolor.
• Systemic mycoses (aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, etc.).

Itraconazole selectively affects fungi without causing damage to healthy human tissues. The effectiveness of the treatment of dermatophytosis of smooth skin with this drug is almost 100%. It should be noted that its use is limited in chronic heart failure, cirrhosis of the liver and serious kidney problems. For pregnant women, Itraconazole may be prescribed in case of systemic mycosis. At the same time, potential risks for the child and the expected result are taken into account. Nursing mothers during drug treatment with antimycotics are recommended to switch to artificial feeding.

Possible side effects from the use of Itraconazole:

• Dyspeptic disorders (complaints of nausea, abdominal pain, vomiting, problems with appetite, etc.).
• Headaches, the appearance of increased fatigue, weakness and drowsiness.
• High blood pressure.
• Allergic manifestations (sensation of itching, rashes, urticaria, Quincke's edema and others).
• Violation of the menstrual cycle.
• Baldness.
• A drop in the level of potassium in the blood.
• Decreased sex drive.

During antifungal therapy, the functional state of the liver is monitored. If changes in the level of liver enzymes (transaminases) are detected, the dosage of the drug is adjusted. Itraconazole is available in capsules. The average price is 240 rubles. Also available under other trade names such as Rumikoz, Orungal, Teknazol, Orunit, Itramikol, etc.

Antimycotic drugs are specific drugs, without which it is impossible to cope with a fungal skin infection.

Fluconazole

Fluconazole is one of the most commonly used antifungal drugs. The level of bioavailability after oral administration reaches 90%. Food intake does not affect the process of absorption of the drug. Flucanosole has proven effective in the following fungal infections:

• Mycosis of the feet, torso nails, etc.
• Various forms of epidermophytosis.
• Multicolored lichen.
• Onychomycosis.
• Candidiasis lesions of the skin, mucous membranes.
• Systemic mycoses.

However, it is not used to treat young children (under 4 years old) and patients who are allergic to the components of the drug. With extreme caution, it is prescribed for serious problems with the kidneys and / or liver, severe heart disease. The expediency of prescribing Fluconazole during pregnancy is decided by the doctor. Basically, these are life-threatening conditions, when the recovery of the expectant mother is put in the foreground. At the same time, when breastfeeding, this antifungal drug is contraindicated.

In some cases, the use of Fluconazole may cause various adverse reactions. We list the most common undesirable effects:

• The occurrence of nausea, vomiting, problems with appetite, pain in the abdomen, diarrhea, etc.
• Headaches, weakness, decreased performance.
• Allergy (itching, burning, urticaria, angioedema, etc.).

Detailed information about drug interactions with other drugs is described in detail in the official instructions for use, which should be carefully read if you are taking any other medications at the same time. It should be noted that the premature termination of therapy usually leads to the resumption of fungal infection. Fluconazole in capsules of domestic production is sold at a price of 65 rubles.

Treatment with antimycotic agents is usually quite long (from several months to a year).

Local antimycotic drugs

Currently, antimycotic agents for local therapy are presented in a wide range. We list the most common:

• Nizoral.
• Lamisil.
• Batrafen.
• Clotrimazole.
• Travogen.
• Pimafucin.
• Exoderil.
• Daktarin.

If an infectious disease is at the initial stages of development, when small lesions are found, they can be limited only to external antifungal agents. Of greatest importance is the sensitivity of the pathogenic microorganism to the prescribed drug.

Lamisil

High therapeutic activity is characteristic of the external drug Lamisil. Available as cream, spray and gel. It has pronounced antimycotic and antibacterial effects. Each of the above forms of the drug has its own characteristics of use. If there is an acute fungal infection of the skin with redness, swelling and rash, it is recommended to use Lamisil spray. It does not provoke irritation and contributes to the rapid elimination of the main symptoms of the disease. As a rule, the spray copes with foci of erythrasma in 5-6 days. With multi-colored lichen, pathological elements on the skin are resolved in about a week.

Like a spray, Lamisil gel must be used in case of acute mycoses. It is applied to the affected areas quite easily and has a pronounced cooling effect. If erythema-squamous and infiltrative forms of a fungal infection are noted, Lamisil cream is used. In addition, this external remedy in the form of a cream and gel is effective for the treatment of patients suffering from microsporia, multi-colored lichen, candidal lesions of large folds and periungual ridges.

On average, the duration of the therapeutic course is 1-2 weeks. Premature termination of treatment or irregular use of the drug can provoke the resumption of the infectious process. If within 7-10 days there is no improvement in the condition of the affected skin, it is recommended to contact your doctor to verify the diagnosis. The estimated price for the drug Lamisil for external use is approximately 600-650 rubles.

Pimafucin

Cream for external use Pimafucin is prescribed for the treatment of fungal infections of the skin (dermatomycosis, fungal infections, candidiasis, etc.). Almost all yeast fungi are sensitive to the action of this drug. It is allowed to use it during the period of bearing a child and during breastfeeding. The only absolute contraindication for the appointment of Pimafucin cream as a local therapy for a fungal infection is the presence of an allergy to the components of an external agent.

You can treat the affected areas of the skin up to four times a day. The duration of the therapeutic course is set individually. Adverse reactions are extremely rare. In isolated cases, irritation, itching and burning sensation, redness of the skin in the area of ​​application of the drug were noted. If necessary, it can be combined with other types of drugs. A prescription is not required to purchase. Pimafucin cream costs about 320 rubles. Also, this medicine is available in the form of suppositories and tablets, which significantly increases the range of its application.

Without first consulting with a qualified specialist, it is strongly not recommended to use antimycotic drugs.

clotrimazole

Clotrimazole is considered an effective antifungal agent for topical use. It has a fairly wide spectrum of antimycotic activity. It has a detrimental effect on dermatophytes, yeast, mold and dimorphic fungi. Depending on the concentration of Clotrimazole in the area of ​​infection, it exhibits fungicidal and fungistatic properties. Main indications for use:

• Fungal infection of the skin, which is caused by dermatophytes, yeasts and molds.
• Pityriasis versicolor.
• Candidiasis of the skin and mucous membranes.

It should be noted that Clotrimazole is not prescribed for the treatment of nails and scalp infections. It is advisable to avoid the use of an antifungal drug in the first trimester of pregnancy. Also, for the duration of therapy, it is recommended to abandon breastfeeding and switch to artificial. Usually this ointment is used three times a day. The duration of treatment depends on the clinical form of the disease and ranges from 1 week to a month. If within a few weeks there is no improvement in the condition of the skin and mucous membranes, you should contact your doctor and confirm the diagnosis with a microbiological method.

In most cases, the external agent is well tolerated. In rare situations, adverse reactions may occur in the form of allergies, redness, blisters, swelling, irritation, itching, rashes, etc. The cost of domestic-made clotrimazole ointment does not exceed 50 rubles.

Nizoral

As dermatological practice shows, Nizoral cream is successfully used for various fungal skin lesions. He is a representative of the azole group. The active substance of the drug is ketoconazole, which is a synthetic derivative of imidazole. It is used for the following diseases and pathological conditions:

• Dermatophyte infections.
• seborrheic dermatitis.
• Dermatomycosis of smooth skin.
• Multicolored lichen.
• Candidiasis.
• Epidermophytosis of the feet and hands.
• Inguinal epidermophytosis.

If there is hypersensitivity to the active substance of the drug, Nizoral is not prescribed. As a rule, an external agent is applied to the affected areas up to two times a day. The duration of therapy depends on the clinical form of the disease. For example, the treatment of patients with pityriasis versicolor can reach 14-20 days. At the same time, therapy of epidermophytosis of the feet averages 1-1.5 months. The occurrence of adverse reactions is not typical. In some patients, redness, itching, burning, rashes, etc. were recorded. If side effects appear or the condition worsens during treatment, you should consult a doctor.

Combined use with other drugs is allowed. During pregnancy and lactation, treatment with an external antifungal agent should be agreed with the attending physician. In most pharmacies, the cost of Nizoral cream usually does not exceed 500 rubles. Price varies by region and distributor.

Fungal infections of the skin often require complex treatment, including systemic, local and symptomatic therapy.

Folk remedies for fungus

Recently, there has been a sharp rise in the popularity of the use of folk recipes for the treatment of various diseases, including infectious diseases. Many traditional healers recommend Furacilin for fungus on the legs. It is used in the form of baths, compresses, etc. However, if you turn to the reference literature, it turns out that Furacilin is active only against bacteria, and is not able to destroy viruses or fungi. Also, many sites are full of information that Furacilin can be used for nail fungus. To avoid such inaccuracies, trust your health exclusively to qualified specialists.

Remember, furatsilin solutions do not treat fungal infections of the skin.

All patients with ringworm tend to opt for topical, topical treatment of the affected areas of the skin. In some cases, this tactic is really successful. But often after local treatment, mycosis returns and with each relapse it becomes more difficult to get rid of it. In this case, treatment with oral systemic drugs is used.

How the drugs work

Broad-spectrum antifungal drugs in tablets are produced on the basis of synthetic antimycotics. Their action is based on the destruction of the membrane of the fungus, increasing its permeability, reducing the ability of the colony to reproduce.

Some fungi develop resistance to certain antimycotics faster than others. Therefore, incomplete treatment may result in the next time you have to select a drug with a different active substance.

The popularity and need for antimycotics is now growing faster, because more and more patients prefer home self-treatment, prescribe antibiotics on their own, take them incorrectly and, as a result, inhibit their own microflora of the body.

Another reason for the popularity of antimycotics is the general decrease in immunity against the background of seasonal respiratory infectious diseases, an unhealthy lifestyle, and chronic diseases.

Consider which broad-spectrum antifungal tablets are most often prescribed today, their action and contraindications.

Polyena

Polyenes represent the class of drugs with the broadest spectrum of activity among all antimycotics. Popular drugs from this group are nystatin, levorin, natamycin. They show their activity against Candida, Trichomonas, and other protozoa.

Resistance to polyenes is shown by dermatomycetes, pseudo-allescheria, therefore polyenes are used for mycoses of the gastrointestinal tract, mucous membranes, and skin.

Nystatin

Highly active drug against fungi of the Candida family. It is not absorbed in the gastrointestinal tract, but in the last period other drugs have come to replace it, although in their absence it is also prescribed.

Indications for use are candidiasis of the skin, mucous membranes of the oral cavity and pharynx, intestinal tract, stomach. In addition, it is prescribed for the treatment of candidiasis after prolonged treatment with antibiotics based on penicillin and tetracycline. It is prescribed to some patients after surgery on the digestive tract to prevent the development of the fungus.

Contraindication to use is only an individual allergic reaction to the drug. Side effects include nausea, vomiting, abdominal pain, diarrhea, and fever.

Levorin

It shows the greatest activity against Candida Albicanis, it is also used against the simplest organisms - Leishmania, amoeba, Trichomonas. It is also used in the treatment of prostate adenoma - when using Levorin, a decrease in the size of the adenoma is noted.

Indications for use are candidiasis of the skin, oropharynx, intestines, carriage of the Candida fungus, mycoses of the gastrointestinal tract.

Contraindicated for use in case of insufficiency of kidney or liver function, in acute intestinal pathologies, non-mycotic nature, during ulcers, pancreatitis, pregnancy. During breastfeeding, it is prescribed only by decision of the attending physician and with careful observation of the patient.

Pimafucin

An antibiotic of an antifungal nature with a pronounced fungicidal effect. Sensitivity to Pimafucin is shown by pathogenic yeast fungi, molds, including:

• Candida
• Penicillium;
• Aspergillus;
• Fusarium.

Pimafucin in the form of tablets begins to dissolve only in the intestines, therefore it has practically no effect on other body systems. Indications for use are thrush, atrophic candidiasis, intestinal mycosis, carriage after long-term treatment with corticosteroids, cytostatics, antibiotics. Not prohibited during pregnancy.

Among the contraindications, only individual intolerance. Adverse reactions include nausea, diarrhea, vomiting, which usually disappear after a few days and do not require discontinuation of the drug.

Azoles

Azoles include synthetic antimycotics, and this group is considered the most effective. It is represented by ketoconazole, itraconazole, fluconazole. The first of them has already lost its popularity due to increased toxicity, but its counterparts in safer forms continue to be used.

Ketoconazole

The drug is based on the active substance with the same name. Shows a therapeutic effect in relation to yeast fungi, higher and dimorphic, dermatophytes.

Assign for infectious diseases of the skin, hair, mucous membranes. Ketoconazole is prescribed only in case of large areas of fungal infection. Effective in chronic candidiasis, dermatophytosis, lichen, folliculitis.

Among the contraindications are the presence of any diseases of the kidneys, liver, the period of bearing a child and breastfeeding, children under three years of age, treatment with hepatotoxic drugs, as well as during the menopause.

Side effects are manifested in the form of pain in the abdomen, nausea, poor appetite, urge to vomit. Drowsiness, dizziness, anemia, leukopenia, impotence, dysmenorrhea, urticaria, photodermatitis are noted.

Itraconazole

Analogues of the drug are Itrazol, Orungal, Orunit, Irunin. Tablets are effective against yeast fungi, dermatophytes, mold. The first therapeutic effect can be assessed only a month after the start of treatment.

Indications for use are vulvocandidiasis, keratomycosis, ringworm, onychomycosis, aspergillosis, cryptococcosis, versicolor, mycosis of the oropharynx. It is also prescribed for sporotrichosis, blastomycosis, histaplasmosis and other types of fungal infections.

Contraindications are high individual sensitivity, pregnancy and lactation, insufficiency of kidney and liver function, abnormalities in the functioning of the hearing aid, severe pathologies of the lungs and bronchi.

Adverse reactions include leukopenia, hypokalemia, thrombocytopenia, anaphylactic reactions, edema, headaches, neuropathy, dizziness, vomiting, constipation, tinnitus, lack of concentration, hepatitis. Erythema, photodermatitis, myalgia, urticaria, erectile dysfunction, amenorrhea, arthralgia are also noted.

Fluconazole

Its popular analogues are Diflucan, Mikomax, Flucostat. Violate the growth of fungal colonies, reduce their ability to reproduce.

Indications:

• Systemic candidiasis affecting the organs of the respiratory system, peritoneum, eyes, reproductive system.
• Cryptococcal lesions - infectious infection of the skin, blood, lungs, meningitis. Candidiasis of the mucous membranes, genitals, and also as a prophylaxis of mycosis in cancer patients.
• With diseases of the fungus of the skin of the foot, nails, with pityriasis versicolor.

Among the side effects are typical phenomena for antimycotics - diarrhea, nausea, abdominal pain, dizziness, leukopenia, erythema, urticaria. Such drugs are taken only during meals, and washed down with plenty of water.

Allylamines

This group of drugs is most often used in the treatment of dermatomycosis of various etiologies and onychomycosis at any stage. Analogues are Bramisil, Lamisil, Terbinox, Terbinafine.

Allylamines exhibit an extensive action against most fungal diseases of the hair, nails, skin, and in small concentrations they are able to fight dimorphic and mold fungi.

Indications for use are fungal infections on the scalp, onychomycosis, fungal infections of the skin of the feet, legs, elbows, neck. With multi-colored lichen, it practically does not show activity orally.

Adverse reactions include lupus, headache, taste distortion, dyspepsia, nausea, poor appetite, diarrhea, myalgia, and psoriasis-like rashes. Prohibited for use in patients with severe liver and kidney failure, pregnant and lactating mothers.

Take orally, regardless of meals, washed down with water. The use of alcoholic beverages during therapy with such drugs is strictly contraindicated.

Despite the ever-growing standard of living, the fungus is found in almost every second inhabitant of the earth. Treatment of any fungal infection is impossible without the use of medicines, but for successful healing it is necessary to use only high-quality and effective antifungal drugs from the list of the best medicines.

The combination of quality and efficiency does not always mean the purchase of super-expensive medicines. There are quite inexpensive drugs against the fungus, which are highly effective and fast acting. In addition, in the treatment of fungus, you can use analogues of expensive drugs that give the same result as the original drug.

Differences and features of antifungal drugs

Drugs against the fungus are selected depending on the duration of the course of mycosis, on the volume of the affected surface, the presence of concomitant diseases, the nature of the manifestations of the fungus.

The forms of release of antifungal agents are diverse - they are available in the form of tablets, ointments, gels, solutions, suppositories. A variety of release forms allows you to treat not only the external forms of mycosis (feet, genitals, toenails and hands), but also the internal manifestations of the fungus. Antifungal drugs in tablets have a systemic effect; gels, ointments, sprays, and creams are used for local treatment.

Modern pharmacology allows you to successfully treat fungal diseases of any nature.

Note! Therapy with a single drug usually does not bring the desired effect, because. often several types of pathogens settle on the body at once. Therefore, the doctor must prescribe a comprehensive treatment of the fungus.

Fungal infection easily adapts to any conditions, quickly developing resistance to various active substances. Therefore, you should not choose the drug for the fungus on your own, because. this can lead to the mutation of the fungus and the development of more resistant forms.

When to use antifungals:

• Mycosis of the foot;
• yeast infection of the skin;
• Cryptococcosis;
• Fungal infections of the respiratory tract, eyes;
• Vaginal;
• Paracoccidioidomycosis;
• Histoplasmosis;
• Epidermophytosis of the inguinal region;
• yeast infection of the skin;
• candidemia;
• esophagus and oral cavity;
• Sporotrichosis;
• Fungus of the scalp;
• diaper rash;
• Body skin fungus.

Medicines against the fungus are aimed at the destruction and destruction of pathogens, and stop the spread of infection. Some of the drugs successfully defeat dermatophytes (mold fungi), others are aimed at destroying yeast fungi directly. Therefore, drugs are selected depending on the type of pathogen, which is determined by the doctor after conducting appropriate tests.

An overview of drugs against fungus

Fungal drugs are classified according to their chemical structure, clinical purpose, and spectrum of action. The most common and effective drug antifungal agents belong to the groups of azoles, polyenes and allylamines.

Polyene group

Polyenes are broad-spectrum antifungal drugs in tablets and ointments that are most popular in the treatment of mycoses. Most often they are used in the treatment of candidiasis of the mucous membranes, skin, gastrointestinal tract.

List of drugs:

• Nystatin - is available in the form of ointments and tablets for the treatment of fungus of the mucous membranes and skin of the body. Used for candidiasis of the skin, intestines, vagina, oral cavity. It has practically no contraindications, side effects in the form of allergic manifestations are possible. The course of treatment lasts from 10 to 14 days (according to the instructions). Price - from 40 rubles.
• Levorin - used for candidiasis of the gastrointestinal tract and skin, has high activity against trichomonas, Candida fungi, leishmania. Not allowed for use during pregnancy, under the age of 2 years, during lactation, with hepatic and, with, ulcers of the intestines and stomach. Price - 100-130 rubles.
• Pimafucin - has an effect on a huge number of pathogenic fungi that affect the body. It is prescribed for candidiasis of the gastrointestinal tract, vagina, to remove the effects of taking antibiotics and corticosteroids. Price - from 250 rubles.

Azole group

Azoles are synthetic drugs used in the treatment of mycoses of the scalp, skin, toenails and hands,. Some drugs in this series are used to treat candidiasis of the mucous membranes and thrush.

List of antifungal drugs:

• Ketoconazole is a drug against dimorphic and yeast-like fungi, folliculitis, dermatophytes, seborrheic dermatitis, chronic candidiasis. Often used for the skin and treatment of head fungus if there is a high degree of damage and resistance to infection. The drug can cause extensive side effects, it is prescribed with caution to children and elderly patients. Price - from 100 rubles.
• Mycozoral is an ointment for the treatment of epidermophytosis, pityriasis versicolor, seborrheic dermatitis, ringworm, candidiasis of various types. Antifungal drugs for nails, hands, feet, based on the active ingredient ketoconazole, are also available in the form of shampoos and oral tablets. Price - from 200 rubles.
• Sebozol is a drug in the form of an ointment shampoo used against yeast-like fungi, dimorphites, and. Used to treat fungal infections of the feet, nails, scalp, hands. Price - from 130 rubles.
• Fluconazole - has a wide range of effects in the defeat of Cryptococcus fungi, candidiasis of the oral cavity and pharynx, respiratory system, organs of the reproductive system, nail fungus, lichen. Capsules are used with caution during pregnancy, with pathological diseases of the liver and heart. Price - from 20 rubles.

Note! Ointments from the fungus can be used as an independent remedy for mycosis, if the affected area is insignificant and the disease is in its initial stage. In other cases, ointments are used as part of the complex therapy of the fungus.

Allylamine group

Preparations of this series are actively fighting ringworm - fungal infections of hair, skin, nails.

The most common drug in this group is Terbinafine. This is a topical preparation (cream, ointment) used in the treatment of nail and skin fungi, dimorphic and mold pathogenic microorganisms. It is prescribed for severe fungal infections of the nails, feet, head, torso. Price - from 48 rubles.

The active substance terbinafine destroys the fungal membrane cells and provokes the death of the fungal colony. In addition, the substance does not accumulate in the body and is removed entirely through the liver, which allows the use of drugs based on it for the treatment of mycoses in pregnant women and children.

Inexpensive antifungal analogues

There are a lot of drugs against the fungus, but basically these drugs are analogues of each other. This happens because, over time, a patented medicinal formula becomes available to other pharmaceutical companies that produce generics based on it - medicines that are identical in composition and action, but at the same time are not so expensive in price.

Generics have their own name of the drug, but you can calculate whose analogue they are by the active substance of the drug, which is prescribed on the package.

Terbinafine, one of the most effective anti-fungal agents, has the following analogues:

• Terbizol;
• Binofin;
• Fungoterbin;
• Exifin;
• Lamikan.

The active substance fluconazole is contained in preparations:

• Fucis;
• Diflucan;
• Nofung;
• Mycosist;
• Mycoflucan.

Ketocanazole has active analogues - Fungavis, Nizoral, Mycozoral.

The cost of antifungal drugs is not always related to quality. Cheap analogues of expensive antimycotic drugs, as a rule, are in no way inferior in effectiveness.

The price of drugs against fungi ranges from very expensive to very cheap drugs with absolutely identical drug efficacy. The most inexpensive analogs are found in a series of drugs based on ketoconazole and fluconazole. Terbinafine analogues occupy a middle position, and the most expensive are preparations based on itraconazole (Itramicol, Irunin, Itrazol, Canditral).

Antifungals for children

Antifungal drugs for children are mainly used topically - ointments, creams, sprays, powders for external use, varnishes, drops, shampoos. Means of local application are based on the action of the active substances of triazole, allialamine, imidazole.

Topical preparations are most effective in the treatment of candidiasis, athlete's foot and tinea versicolor.

With a candidal child, drugs are prescribed in the form of tablets or plates for resorption. Treatment of a fungal infection in the organs of vision is based on the use of a suspension with nystatin. in children, it is treated with a special varnish, which not only neutralizes fungal colonies, but also creates a protective film on the nail plate.

The most common topical preparations are:

• Mycosan;
• Nystatin;
• Amorolfine.

Systemic therapy is carried out only under the condition of the occurrence of large lesions and their rapid spread. Systemic drugs include:

• Fluconazole;
• Mycoseptin;
• Terbinafine.

Self-treatment with antifungal drugs in pediatrics is not allowed, because. medicines have a number of side effects and contraindications. The correct treatment plan can only be drawn up by a qualified doctor.

Nail fungus is considered one of the most common diseases, and its treatment requires the use of various medications. It is simply impossible to form immunity to such a disease, and maintaining personal hygiene is considered the main preventive method. To combat pathology, various antifungal drugs have been created in the form of ointments, tablets, creams, varnishes and sprays.

In the absence of a positive effect after local treatment of the affected areas of the skin, therapy with oral and systemic medications is selected. The use of the latest antifungal agents allows not only to cope with the disease, but also to prevent its occurrence in the future.

The first signs of mycosis attack

Timely diagnosis allows you to start mycosis therapy as early as possible and choose an antifungal agent. There are special signs of mycosis, which may indicate a disease:

• coarsening of the skin on the legs;
• the appearance of cracks in the heel area;
• staining of the epithelium in red;
• thickening of the nail plate;
• severe exfoliation of the epidermis;
• the formation of yellow spots or stripes on the nails;
• severe itching and burning.

With the disease, stratification of the nail, changes in the boundaries of its edge and partial destruction of the plate are noted.

Drug treatment of the fungus

Antifungal agents that are used to treat mycosis are called antimycotics. This term combines different types of medicines against the fungus, which are characterized by high efficiency in treatment. Some types of external fungus removers are obtained only in chemical laboratories, while others are obtained from natural compounds. All medications for the treatment of fungal infections are classified into the following groups, taking into account:

1. pharmacological composition;
2. features of the effect of the drug on individual strains of fungi.

All antifungal drugs in the form of tablets have certain contraindications to their use and can provoke adverse reactions. Given this feature, they can only be prescribed by a dermatologist. In addition, it is the specialist who determines the dosage of broad-spectrum antifungal drugs in tablets and the duration of their use.

In the event that the patient is prescribed oral medication, it is necessary to observe the duration of the intake and a certain frequency. This means that you need to use the remedy at the same time for treatment, avoiding gaps and in no case doubling the dose. The fact is that a violation of the sequence of treatment or its premature completion can cause the re-development of the fungus of the feet and nails. Only a specialist can choose the most effective remedy for a fungus.

How do fungal pills work?

The effectiveness of drugs with an antifungal effect, produced in tablet form, is based on their fungicidal properties. This means that antifungal tablets accelerate the elimination of mycosis spores and inhibit the further reproduction of pathogenic microflora.

When taken orally, the antimycotic agent penetrates into the blood in a short time and actively affects the spores. In the human body, the active ingredient remains in an active state for a long time, after which it is naturally excreted. There are various groups of medicines that differ from each other in pharmacological features. In the treatment of fungal infections, the following drugs can be used:

• Antibiotic antifungal drugs in tablet form, in which the main component is ketoconazole. With their help, it is possible to slow down the formation of the membrane of the pathogen at the cellular level.
• Preparations for mycosis with terbinafine and itraconazole. Such agents disrupt the production of ergosterol and thereby prevent the reproduction of pathogenic cells.
• Medicines containing fluconazole. With their help, it is possible to destroy the cells of the pathogen, and prevent the formation of new ones.
• Griseofulvin tablets for internal use help to avoid spore division and further progression of the disease.

Typology of effective remedies for fungus

All lesions of the skin specialists are divided into the following groups:

1. external fungal diseases affecting the hairline, epithelium and nails;
2. internal or hidden mycoses attacking internal organs.

In the treatment of pathologies of fungal etiology, the following are usually used:

• local antibacterial antifungal agent;
• antifungal agents with a wide spectrum of action, designed to destroy the fungus.

Before prescribing antifungal therapy, clinical studies must first be carried out, according to the results of which the most effective remedy against a particular strain of mycosis is selected. In the treatment, griseofulvin is especially effective, helping to quickly destroy the spores of the fungus.

Groups of effective antifungal drugs

Antifungal tablets are divided according to their chemical structure, spectrum of action and clinical purpose. All modern antifungal drugs for human oral administration are conditionally divided into several groups with the following names:

1. polyenes;
2. azoles;
3. alliamids.
4. pyrimidines;
5. echinocandins.

Some fungi develop resistance faster than others to certain broad-spectrum antifungal tablets. It is for this reason that incomplete drug treatment can lead to the fact that the next time you have to prescribe a medication with a different active ingredient.

Important! Preparations in tablets and solutions must be used in a strict dosage, selected by the doctor. The duration of therapy is determined by the form of the drug and composition.

The first group of polyene antimycotics

Polyenes are strong, powerful, versatile antifungals that come in tablet and ointment form. They are mainly prescribed for the treatment of candidiasis of the skin, mucous membranes and gastrointestinal tract. The following drugs of the polyene group are considered the most effective in the fight against the disease:

• Nystatin;
• Levorin;
• Pimafucin.

Thanks to the antimycotics of this group, candidiasis of the genital mucosa and epithelial tissue, as well as fungal infections of the stomach, are treated.

The second group of antifungal agents - azoles

Azoles are modern antifungal drugs that are used to treat mycoses of the scalp, skin, nails and lichen. Some medicines of this group are prescribed for the treatment of candidiasis of the mucous membranes and thrush. The fungicidal properties of azoles are manifested in the destruction of fungal cells, and a positive effect can only be achieved at high concentrations of antimycotics.

This group of drugs is considered the most effective, and its representatives are:

1. Ketoconazole. The drug is based on the active ingredient with the same name. Ketoconazole is prescribed for the treatment of yeast-like mycoses, dermatophytes, a chronic form of candidiasis and multi-colored lichen. The use of the drug can cause adverse reactions, and any pathology of the kidneys and liver is considered a contraindication to therapy.
2. Itraconazole. such tablets are effective against yeasts and molds, as well as dermatophytes. Intraconazole is found in preparations such as Orungal, Orunit, Irunin, Itramikol and Canditral.
3. Fluconazole. Such an antifungal drug is considered one of the best against the disease, and helps to stop the growth of mycoses in the human body. The drug is prescribed for the treatment of candidiasis, dermatophytosis and deep mycoses. As an active ingredient, fluconazole is contained in drugs such as Diflazon, Mikoflyukan, Diflucan, Flucostat and Fungolon.

The third group - alliamids

Antifungal agents of the alliamid group are effective in the treatment of dermatomycosis - fungal infections of the skin, nails and hair.

The most common drug in this group is Terbinafine, which has a fungistatic and fungicidal effect. The medicine helps in the fight against dermatophytosis, candidiasis, chromomycosis and deep mycoses.

An antifungal drug that contains the active substance naftifine is Exoderil cream and solution. Such a tool is used for the treatment of nails and skin, and the inflamed area of ​​\u200b\u200bthe skin is lubricated once a day.

The drug for severe forms of mycosis

For the treatment of complicated mycotic forms, a broad-spectrum antifungal drug in tablets such as Griseofulvin can be prescribed. It is used to eliminate microsporia of hair, epithelium and nails, as well as to combat trichophytosis, ringworm and epidermophytosis. A contraindication to treatment with such a mycotic drug is children under 2 years of age, oncological pathologies, pregnancy and the period of breastfeeding. Adverse reactions may appear in the work of the digestive and nervous systems, and allergies are also possible.

Preparations for external fungus removal

For the treatment of epithelial fungus, the following fungicidal antifungal drugs of systemic action can be prescribed:

• Lotriderm;
• Triderm;
• Seacorten;
• Sinalar;
• Travocort.

Medicinal varnishes Lotseril and Batrafen, which should be applied to the affected nail plate, are considered an effective drug. They quickly penetrate the human nail, effectively fight the disease and form a protective film on its surface. For local therapy of mycosis, it is recommended to use antimycotic shampoos such as Mycozoral, Cynovit and Sebiprox.

It is possible to completely get rid of the fungus only with the help of a complex treatment selected by a doctor. It involves taking oral medications, increasing the body's immunity and local treatment of damaged areas of the epithelium.