Oral antifungal medication
Oral antifungal medications may be required for a fungal infection if:
- It is extensive or severe.
- It resists topical antifungal therapy.
- It affects hair-bearing areas (tinea capitis and tinea barbae).
The choice of oral antifungal medication, its dose and the duration of treatment depends on:
- The type of fungus i.e. candida, dermatophyte (tinea), malassezia, or mould.
- The site affected i.e. skin, mucosa, nails.
- Other co-existing diseases.
- Interactions with other medications.
Medication for both candida and dermatophyte infections (azoles)
The trade names of the medications sold in New Zealand are given in parentheses.
- Itraconazole (Sporanox® capsules).
- Ketoconazole (Nizoral® tablets).
- Fluconazole (Diflucan® capsules).
Some species of candida are resistant to azoles, and azole resistance is increasing especially in immunosuppressed patients who are prescribed long courses.
Medications only suitable for candida infections
- Nystatin (Mycostatin®, Nilstat®), a polyene. This is not absorbed into the blood stream through the gut.
- Flucytosine (Alcobon® infusion), usually used with amphotericin. It can cause bone marrow depression.
- Amphotericin B (Ambisome® injection; Fungizone® infusion), a polyene. This is not absorbed into the blood stream through the gut.
- Caspofungin, anidulafungin and micafungin (echinocandins)
Medications only suitable for dermatophyte infections
- Griseofulvin (no longer available in New Zealand), derived from Penicillium
- Terbinafine (Lamisil®, Terbafin® tablets), an allylamine.