Antifungals

Commonly Prescribed Drugs

See Mechanism of Action of Select Antifungals table.

Pharmacologic Profile

General Use

Treatment of fungal infections. Infections of skin or mucous membranes may be treated with topical or vaginal preparations. Deep-seated or systemic infections require oral or parenteral therapy.

General Action and Information

MECHANISM OF ACTION OF SELECT ANTIFUNGALS

DRUG	MECHANISM
Anidulafungin, caspofungin, and micafungin	Echinocandins: inhibit β-1,3-glucan synthase → weakens fungal cell wall
Butenafine, naftifine, and terbinafine	Inhibit squalene epoxidase → disrupts ergosterol synthesis →↓ fungal cell membrane synthesis
Butoconazole, clotrimazole, econazole, efinaconazole, isavuconazonium, ketoconazole, luliconazole, miconazole, oxiconazole, posaconazole, sertaconazole, sulconazole, terconazole, tioconazole, and voriconazole	Azole antifungals: inhibits fungal cytochrome P450 → disrupts ergosterol synthesis →↓ fungal cell membrane synthesis
Ciclopirox	Inhibits transport of essential elements in fungal cell, disrupting synthesis of DNA, RNA, and protein
Nystatin	Binds to ergosterol in fungal membranes → leakage of cell contents → changes fungal cell membrane permeability
Tavaborole	Inhibits fungal protein synthesis
Tolnaftate	Distorts the hyphae and stunts mycelial growth in fungi

Contraindications

Previous hypersensitivity.

Precautions

Because most systemic antifungals may have adverse effects on bone marrow function, use cautiously in patients with depressed bone marrow reserve. Fluconazole requires dosage adjustment in the presence of renal impairment. Adverse reactions to fluconazole may be more severe in HIV-positive patients. The IV formulation of voriconazole should be avoided in patients with renal impairment.

Interactions

Differ greatly among various agents. See individual drugs.

Nursing Implications

Assessment

Assess patient for signs of infection and assess involved areas of skin and mucous membranes before and throughout therapy. Increased skin irritation may indicate need to discontinue medication.

Implementation

Available in various dosage forms. Refer to specific drugs for directions for administration.
Topical: Consult physician or other health care provider for cleansing technique before applying medication. Wear gloves during application. Do not use occlusive dressings unless specified by physician or other health care provider.

Patient/Family Teaching

Instruct patient on proper use of medication form.
Instruct patient to continue medication as directed for full course of therapy, even if feeling better.
Advise patient to report ↑ skin irritation or lack of therapeutic response to health care provider.

Evaluation/Desired Outcomes

Resolution of signs and symptoms of infection. Length of time for complete resolution depends on organism and site of infection. Deep-seated fungal infections may require prolonged therapy (weeks–months). Recurrent fungal infections may be a sign of serious systemic illness.

Antifungals included in Davis's Drug Guide for Nurses

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Information