So-called antifungal medications are used to treat fungal infections. They can be administered either topically (i.e., locally) or systemically (throughout the body). Sometimes both forms of treatment are combined. Several active ingredients are available, each with a different mechanism of action.
Here you will find further information as well as a selection of antifungal specialists for treating fungal infections.
Antifungals are medications used to treat fungal infections (medically known as mycosis).
They can be specifically targeted at a particular type of fungus and effectively combat it. These are referred to as narrow-spectrum antifungals.
Other antifungal medications are not specialized for a specific fungal pathogen but instead target fungi in general. These are known as broad-spectrum antifungals.
Antifungals can effectively treat a fungal infection when used correctly. In addition, you should follow certain hygiene rules to prevent the spread of the infection. These include, for example:
The active ingredients in antifungal medications can affect the fungus in different ways:
Generally, antifungals target the production centers of fungal cells—their cell membranes. They do not kill fungal cells directly but rather alter the “blueprint” of the substances produced in the cell membranes.
Active ingredients such as imidazoles and triazoles block an important enzyme, for example. Without this enzyme, the fungal cells produce an incorrect building block that disrupts the fungal metabolism. As a result, the fungus can no longer reproduce. The fungal infection does not spread further, and the body gradually eliminates it through skin renewal. The fungus is thus treated fungistatically.
Some antifungal agents in the imidazole group, such as clotrimazole and miconazole, cause the production of significantly altered building blocks. These prevent the fungus from forming intact cell membranes. As a result, the cell’s contents leak out, and the fungus eventually dies. This is why clotrimazole and miconazole are also referred to as fungicidal antifungal agents.
Athlete’s foot pathogens thrive in the warm, moist environment of poorly ventilated athletic shoes © misalukic | AdobeStock
In fungal therapy, a distinction is also made between topical and systemic treatments. For some fungal infections, a combination of both treatment forms may be appropriate.
Topical antifungals are applied directly to the skin’s surface. These typically include
The patient applies the antifungal medication directly to the fungal infection.
This form of antifungal therapy is appropriate for fungal infections on the body’s surface that are not too widespread, specifically on the
They have proven effective, for example, in treating
Topical treatments can effectively treat localized fungal infections. They do not affect the entire body but may cause only localized side effects, such as skin reactions.
Accompanying symptoms of a fungal infection, such as itching or burning, are treated with supportive medications. Even with successful antifungal therapy, these local symptoms often do not disappear until the skin cells have regenerated. This can take several weeks.
Fungal infections can spread further, especially in people with weakened immune systems. Those affected often include
In systemic fungal infections, the fungal pathogens are present in the bloodstream and can therefore infect any organ. Topical therapy is no longer sufficient in such cases.
Other reasons for systemic antifungal therapy include:
In these cases, antifungal medications are administered as part of systemic therapy. The patient receives the antifungal medications in the form of tablets or infusions. Capsules or liquid formulations may also be used in systemic therapy.
The antifungal medication enters the bloodstream and acts throughout the body. The medication usually contains active ingredients from the groups of
Using different mechanisms, all three classes of drugs damage the cell wall components of the fungal pathogens. In this way, they inhibit their growth.
Not every patient is a suitable candidate for systemic therapy. People with liver disease and pregnant women are excluded from this treatment.
Systemic antifungal therapy can also cause side effects:
However, modern systemic therapy medications are well tolerated and are less likely to cause side effects.
The success of treatment for a fungal infection depends crucially on using the right medication. Therefore, treatment can only be as effective as the initial diagnosis.
Generally, many topical antifungal medications are available over the counter at pharmacies. A visit to the doctor is therefore not always necessary. Some fungal infections can be easily diagnosed even by laypeople. If the infection is not yet advanced, there is no reason not to treat it yourself.
Many fungal infections can be treated at home with over-the-counter antifungal medications © Siniehina | AdobeStock
You should never delay treatment. A fungus that affects large areas of the body can cause serious health problems. Without treatment with effective medications, the infection can lead to systemic mycosis. Early topical treatment, as recommended by a healthcare professional, stops the fungus from spreading and prevents the condition from becoming severe.
A visit to the doctor is necessary in the following cases:
The doctor will first conduct a thorough diagnosis to identify the pathogen. In some cases, the site of infection indicates the fungus involved in the disease process. Vaginal yeast infections, for example, are caused by the yeast Candida albicans in 90 percent of cases.
To precisely identify the pathogen, the doctor may perform a pathogen test. Using a swab, the doctor takes a small sample from the infected tissue. In the laboratory, the isolated fungal pathogen is cultured. After one to four weeks, the fungus has developed sufficiently. An examination under a microscope then reveals the specific type of fungus present in the sample.
The doctor then selects the most effective medication and determines the duration of the antifungal treatment.
Whether with or without a doctor: Treating a fungal infection requires the patient to strictly adhere to the treatment regimen. A successful cure is only achieved if the frequency and duration of treatment are strictly followed. Be sure to follow the instructions in the package insert or your doctor’s instructions.
Treatment must be completed in full, even if no fungal infection is longer visible. The absence of symptoms does not yet indicate that the treatment goal has been achieved in the case of a fungal infection. Fungal pathogens could survive in the skin and multiply again later if treatment is stopped too early.
Nystatin is the classic antifungal medication. As early as 1950, two American women discovered an effective antifungal agent that is still in use worldwide today. They isolated a natural antifungal compound from bacteria, which the bacteria use as a defense against fungal infections.
Nystatin is one of the few highly effective antifungal medications that has virtually no side effects. The medication makes the outer wall of the fungal cell permeable and disrupts its respiration.
The nystatin molecules are so large that they cannot penetrate the intestinal wall. As a result, the substance in the antifungal agent leaves the digestive tract unchanged. This is why even pregnant women are permitted to use the antifungal agent nystatin.
When applied to the skin, this antifungal medication is used to treat yeast infections in the form of an ointment, cream, or paste. For vaginal yeast infections, nystatin is administered as a vaginal suppository.
The antifungal agents natamycin and amphotericin B are chemically closely related to nystatin. These antifungal agents work in the same way as nystatin. Sometimes doctors also prescribe the antifungal agent amphotericin B as an intravenous infusion. This allows the antifungal agent to enter the intestines via the bloodstream, where it kills the fungi.
However, this antifungal treatment is only recommended for severe fungal infections when other medications are ineffective. It can cause serious side effects.
If fungi have
, oral antifungal medications alone are no longer effective. The same applies to persistent fungal infections that have reached deep layers of the skin or to nail fungus.
In such cases, many doctors prescribe antifungal medications that penetrate the intestinal wall and act throughout the entire body. However, this systemic therapy can cause serious side effects.
One such antifungal medication is ketoconazole. This antifungal can occasionally cause kidney damage and is now rarely administered orally.
Imidazoles are another group of antifungal agents and, together with triazoles, form the azole antifungals. Azole antifungals constitute the largest group of antifungal agents used to treat fungal infections.
They have a broad spectrum of activity, meaning they can be used against many different pathogens. Imidazoles and triazoles are generally used to treat fungal infections
. As antifungal agents, they are generally used topically.
The following are used topically or locally:
Available in various suitable dosage forms, these antifungal agents can be applied to
. In these areas, the antifungal agents are very effective and well tolerated.
Most of the antifungal agents mentioned must be applied twice a day. Modern antifungal agents such as bifonazole or croconazole need to be applied only once a day.
However, ketoconazole and miconazole can also be used for internal treatment. Miconazole, for example, can be administered in a hospital as an infusion directly into the bloodstream.
Ketoconazole is less suitable for injections and infusions. However, like miconazole, it can be used to treat fungal infections of the stomach and intestinal mucosa.
Oral antifungal medications such as the imidazoles can cause severe side effects. For this reason, better-tolerated antifungal medications, such as the triazoles, are currently preferred. These include the antifungal medications
The antifungal agent itraconazole primarily combats
Fluconazole is an antifungal agent that is particularly effective against yeasts and cryptococci.
The antifungal agent voriconazole combats Candida strains.
