The best antifungal drugs: review and classification. Pharmacological group - Antifungal agents Antimycotic drugs

Treatment of any fungal infections is impossible without the use of medications, but for effective healing it is recommended to use only effective and high-quality antifungal drugs. Combining effectiveness and quality does not mean purchasing expensive medicines. There are quite a few inexpensive anti-fungal medications on pharmacy shelves that are fast-acting and highly effective. When treating mycosis, you can use analogues of expensive drugs that give the same results as the original drugs.

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Differences and features of antifungal medications

Depending on the duration of mycosis, the presence of a concomitant disease, the volume of the affected skin surface and the nature of the manifestations of the fungus, antimycotic drugs are selected.

The forms of release of such medicines are quite varied - they are available in the form of ointments, tablets, solutions, gels and suppositories. This diversity makes it possible to treat both external forms of mycosis (nail plates on the hands and feet, feet, genitals) and internal fungal manifestations. Antifungal agents in tablets can have a systemic effect; creams, gels, sprays and ointments are used for local therapy.

Treatment of fungus with one drug most often does not bring the expected result, because several types of pathogens often settle on the body at the same time. For this reason, the doctor usually prescribes complex therapy for the fungus.

The cost of some drugs is relatively low due to the absence of costs for the invention of the active ingredient or original formula, mark-up for the brand, etc. Domestic products are cheaper than foreign analogues

Groups of the most effective antifungal drugs

Depending on the athymycotics present in the composition and their pharmacological effects, several groups of antifungal drugs are distinguished.

Polyenes

The first group of antimycotics are polyenes, which act on most pathogenic microflora.

Drugs included in the polyene group of antimycotics for internal use:

Drug name	Description of the product	Price	Photo of medicine
Nystatin	One of the cheapest drugs of the polyene group. The drug is very effective in the treatment of mycotic lesions such as Candida of the gastrointestinal tract, epithelium and mucous membranes of the larynx that occur as a result of long-term use of antibiotics or after surgery. Contraindication: hypersensitivity to the drug. Very rarely, adverse reactions such as increased body temperature, histamine reaction and painful conditions of the gastrointestinal tract may occur.	from 60 rub.
Levorin	A modern antifungal medicine that also acts on amoebas, trichomonas and leishmania. Used for the treatment of mucous membranes of the gastrointestinal tract, candidiasis of the epithelium, larynx and oral cavity and in the complex treatment of prostate hypertrophy in men. It is prohibited for patients with liver or kidney failure, inflammation of the gallbladder and exacerbation of peptic ulcers, as well as for women during pregnancy. Adverse reactions include loss of appetite, nausea, diarrhea and vomiting. In rare cases, allergic reactions to individual components of the product may occur.	100 - 130 rub.
Pimafucin	The antibiotic effectively affects yeast mycoses Penicillium, Candida, Cephalosporium, Fusarium. It is used for the treatment of candidiasis of the gastrointestinal tract, ears, vagina and atrophic candidiasis while taking antibacterial drugs and hormonal agents. When taken orally, Pimafucin tablets act only in the stomach, without having a systemic effect in the body. Can be used during breastfeeding and pregnancy. Side effects are minor - nausea, stomach upset, which go away after 1-2 doses	about 250 rub.
Amphotericin B	The release form of the drug is powder for the preparation of infusions. A strong antimycotic drug that is prescribed for severe forms of life-threatening mycotic lesions - peritonitis, disseminated varieties of candidiasis, sepsis caused by fungus, inflammation and infection of internal organs. It has a fungistatic and fungicidal effect. It disrupts the permeability of the membrane, resulting in the release of intracellular substances into the extracellular space and lysis of the fungus.	from 30 to 50 rub.

Azoles

Drugs included in the azole group of antimycotics are inexpensive antifungal agents of synthetic origin.

Name of medicine	Description of the product	Price	Photo of the drug
Ketoconazole	One of the very cheap drugs to combat fungi. Belongs to the group of azoles (the best medicines for fungus of the epithelial nail plates, certain strains of lichen and hair). The medicine contains an active ingredient such as imidazoledioxolane. This antibiotic is effective in the treatment of higher, yeast-like, dimorphic mycoses and dermatophytes. The use of antifungal tablets is recommended for chronic forms of candidiasis, folliculitis, recurrent vaginal mycosis and lichen versicolor. The drug is more effective in combating fungus that is resistant to other antimycotics. Contraindication: chronic diseases of internal organs. Adverse reactions such as surges in blood pressure and allergic reactions in the form of rashes, indigestion and nausea, drowsiness and dizziness have been observed.	from 100 rubles for 10 tablets
Itraconazole	Chemical antifungal capsules are effective against a wide range of fungal strains, such as yeast, mold, and dermatophytes. Using the product, it is possible to defeat vaginal and vulvocandidiasis, dermatomycosis, keratomycosis, lichen versicolor and candidiasis of the oral mucosa, mycosis of the nail plates and cryptococcosis, blastomycosis and sporotrichosis, as well as histaplasmosis. It is contraindicated to take the medicine during pregnancy and breastfeeding.. Possible adverse reactions in the form of vision problems and skin rashes, as well as menstrual irregularities in women	about 285 rubles for 14 capsules
Fluconazole	One of the most effective antifungal agents that prevents the growth of fungi in the body and resists their replication. Recommended for the treatment of candidiasis of the genitourinary system, candidiasis of the respiratory tract, generalized candidiasis of the gastrointestinal tract, sepsis, candidiasis of the mucous membranes of the eyes, meningitis caused by Cryptococcus fungi, candidiasis of the larynx, mouth and lower respiratory systems, candidiasis of the genitals, onychomycosis and mycosis of the skin of the feet, mycosis of the epithelium and pityriasis versicolor . It is not recommended for use during breastfeeding; it is prescribed with caution to women during pregnancy and to persons with heart disease. Possible side effects - allergic reaction and digestive problems, if there is individual sensitivity	about 24 rubles for 7 tablets
Mycomax	The antifungal drug disrupts the synthesis of cell walls of the pathogenic fungus, as a result of which the development of infection stops. The drug is effective when the body is infected with fungi of the genus Candida (Candida), Mycosporum, Cryptococcus or Trichophyton. Mycomax is prescribed for the treatment of thrush, mycoses of the feet, body, groin, pityriasis versicolor and nail fungus. Effective in the fight against candidomycosis of the mucous membranes of the mouth, esophagus, and meningitis. Contraindicated in pregnancy, lactation, hypersensitivity to the components of the drug and under 3 years of age (capsules)	from 230 rubles for 3 capsules

It is important to remember that azole group drugs are recommended to be taken with food, with plenty of water. Antimycotics are incompatible and prohibited for simultaneous use with Terfenadine, Pimozide, Quinidine, Astemizole and Lovastatin.

Alliamides

This group includes synthetic drugs that can remove fungus from the body. Alliamides affect dermatomycosis - infectious fungi of the epithelium, nail plates and hair.

Terbinafine is a synthetic broad-spectrum drug used in the treatment of fungal infections of the epidermis, nails and hair that were caused by fungi and dermatophytes of filamentous fungi. Even a low concentration of the product can completely kill all types of dermatophytes and molds, as well as types of dimorphic, yeast-like (Candida albicans), yeast fungi.

The drug acts on yeast fungi in both a fungicidal (completely destroying mycosis) and fungicidal (slowing down their growth) method, depending on the type of microorganisms being destroyed.

The drug is contraindicated for persons with chronic kidney and liver diseases, and for women during breastfeeding and pregnancy. Side effects are possible in the form of allergic rashes, taste bud disturbances, headaches and problems with food absorption. The drug is taken orally, regardless of food intake. The product is incompatible with alcohol. The price of the drug is from 48 rubles.

Antifungal capsules and tablets require prior prescription by a specialist. During the treatment period, blood biochemistry can be monitored. Independent reduction of the drug dose and discontinuation of therapy is unacceptable. This can provoke the development of resistant strains of the fungus and cause a relapse of the disease.

Echinocandins

The mechanism of action of drugs in this group is unique among antifungal drugs. The powerful action of echinocandins is directed towards the cell wall of the fungus, which gives them an advantage because they do not have cross-resistance with other drugs.

Drugs in this group are used in the treatment of various forms of candidiasis, aspergillosis and other mycoses. Available for intravenous administration only. The most common are Caspofungin (used for severe forms of candidiasis as prescribed by a doctor, as it has many contraindications) and Anidulafungin (prohibited for use under 18 years of age, during pregnancy, and for liver diseases).

Caspofungin

Pyramidines

Antimycotics of this group have a wide spectrum of action. They penetrate inside the fungal cell and disrupt the synthesis of proteins important for fungi, destroying their DNA. Pyramidins are used to treat complicated candidiasis, cryptococcosis, aspergillosis, and chromoblastomycosis.

A representative of this group is the drug Flucytosine (Ancotil), produced in the form of tablets and solution for injection. The drug is usually used together with amphotericin B in the treatment of complicated fungal diseases. Price from 224 rubles.

Flucytosine

A remedy for severe forms of mycosis - a natural antimycotic from the group of grisans

The drug Griseofulvin belongs to the group of grisans (non-polyene antibiotics) and is effective in the fight against dermatomycetes. This is the best cure for fungus. Treatment with the drug is effective in the most severe forms of fungal diseases. But the treatment of mild mycotic manifestations with this remedy is not justified.

The following strains are susceptible to Griseofulvin:

Achorionum;
Trichophyton;
Epidermophyton;
Microsporum.

The medicine is prescribed for the treatment of microsporia of nails and hair, epithelium, trichophytosis, ringworm, and epidermophytosis. It should not be taken by children under 2 years of age and by patients with chronic diseases of the gastrointestinal tract and blood, with oncology, during pregnancy and breastfeeding. Side effects are possible from the nervous and digestive systems; with individual sensitivity to the ingredients of the drug, allergic manifestations are possible. Price - from 250 to 350 rubles.

You cannot self-medicate. If the antimycotic is chosen incorrectly, it will not bring the expected effect, and prolonged use can cause skin rashes and damage to internal organs.

Medicines for children

If candidal stomatitis (thrush) is present in a child, then medications are usually prescribed in the form of tablets or wafers. When treating a fungal infection in the organs of vision, the doctor will rely on the use of a suspension containing nystatin. Mycosis of the nail plates in a child is treated with a special varnish that neutralizes fungal colonies and creates a protective film on the nail.

When large foci of fungal infection occur in children, systemic therapy is used. Systemic medications include:

Terbinafine (from 48 rubles);
Fluconazole (from 24 rubles);
Mikoseptin (from 348 rubles).

In pediatrics, self-treatment with antifungal agents is not allowed, because the drugs have a number of contraindications and side effects. The optimal treatment plan should only be drawn up by a qualified doctor.

Most people have experienced itching near the nails, redness of the side ridges, and unpleasant odor from the feet, but this is not the only type of fungal infection - only the most common. If the lesion covers a large area or affects internal organs, local treatment is not enough: tablets are needed.

What are antifungal drugs in broad-spectrum tablets

Antimycotics are the names of drugs that have a fungistatic (suppress activity) or fungicidal effect (kill) on fungal microorganisms. They can be of natural or synthetic origin, work narrowly or have a broad spectrum of action, which means they are effective against several groups of fungal microorganisms. Systemically (tablets) they are prescribed for:

severe course of the disease;
large affected area;
infection of internal organs;
the need to protect against fungal disease (if there is a high risk of infection).

The main advantage of such systemic drugs is their effectiveness - they act on several different pathogens at once and do it quickly, suitable for severe infections. The downside is high toxicity, a large number of contraindications and side effects, so you need to carefully consider the doctor’s recommendations and the prescribed dosage regimen. Broad-spectrum antifungal drugs in tablets can cause:

liver damage (hepatotoxic);
estrogen fluctuations;
severe allergic reactions;
anaphylactic shock.

How to use

Antifungal drugs with a broad spectrum of activity for systemic treatment can be used parenterally (dropper with a solution) or orally. The specific regimen of use depends on the active substance, the form of the disease, and the patient’s condition. A few key points:

The absorption of allylamines does not depend on food intake, so they can be taken at any time, and azoles must be taken with meals. It is advisable to use antibiotics not on an empty stomach to reduce the likelihood of mucosal irritation.
It is advisable to take antimycotics only with clean water. An exception is when treating patients with azoles with low stomach acidity: they should take the tablet with an acidic liquid (tea, pasteurized milk).
Griseofulvin should be taken with a tablespoon of vegetable oil, especially if the patient is on a low-fat diet.
Antifungal agents are used according to a schedule, observing the dosage time and intervals (necessarily equal intervals). If you forget, take the tablet as soon as you remember, but do not increase the single dosage.
Capsules must not be destroyed (cut, empty contents). The tablet can be divided if necessary to reduce the dosage.

Classification of broad-spectrum antifungal drugs in tablets

Official medicine has several ways of dividing antimycotics into categories. By origin they are synthetic (artificial) and natural. The classification by chemical structure (active substance) is more extensive:

Azoles: derivatives of triazole, imidazole.
Allylamines.
Echinocandins.
Polyene antibiotics.
Drugs of other chemical groups: ciclopirox, griseofulvin, flucytosine.

Antifungal antibiotics

Antibiotics from the macrolide group of the polyene series have the widest possible spectrum of action and are highly effective in combating fungus - they do not affect only dermatomycetes with pseudoallescheria. They primarily destroy representatives of the genus Candida, but can also be active against filamentous and dimorphic fungi, Trichomonas, amoebas, and Leishmania. Known polyenes in tablets:

Amphotericin B;
Levorin;
Nystatin;
Mycoheptin;
Natamycin.

They all work through binding to the ergosterol of the fungal cell membrane, which leads to a violation of its integrity and subsequent lysis (death) of the cell. Each of the polyene antibiotics has its own spectrum of action and a list of organisms sensitive to it, so they are not interchangeable. When taking tablets, the active substances from the gastrointestinal tract are almost not absorbed. Pimafucin is considered a highly effective antifungal drug of this type, which does not have a systemic effect, working only in the digestive tract:

Active ingredient: natamycin.
Indications: non-invasive intestinal candidiasis (treatment/prevention), including those caused by drug therapy.
Side effects: in the first days of use, diarrhea, nausea.
Contraindications: intolerance to the active substance.

A powerful representative of polyenes is Levorin, which is active against yeast-like fungi and is prescribed for a long course (10-12 days). If necessary, treatment is carried out twice. Features of Levorin:

Active ingredient: levorin.
Indications: gastrointestinal candidiasis, carriage of fungi of the genus Candida.
Side effects: diarrhea, nausea, vomiting, loss of appetite, headache.
Contraindications: liver or kidney failure, hypersensitivity, pancreatitis, ulcers, acute intestinal diseases (not of fungal etiology), pregnancy. Levorin should be used with caution in children under 2 years of age and during breastfeeding.

Nystatin is a cheap polyene antibiotic based on the active substance of the same name, which can be prescribed not only for the active treatment of fungal infections, but also for the prevention of infection. Key points:

Active ingredient: nystatin.
Indications: candidiasis of the skin, mucous membranes, internal organs. Long-term treatment with antimicrobial agents (prevention).
Side effects: nausea, vomiting, itching, fever.
Contraindications: peptic ulcer, pancreatitis, liver problems, pregnancy, sensitivity to the composition.

Among the antifungal antibiotics of the non-polyene group, doctors highlight the drug Griseofulvin: it works on the substance of the same name, which has a fungistatic effect. Produced by mold fungi, it causes disruption of cell wall synthesis, inhibits cell division and protein production. Tends to accumulate in the cells of nails, hair and skin. Features of Griseofulvin tablets:

Active ingredient: griseofulvin.
Indications: dermatophytosis of the scalp, epidermophytosis (trichophytosis) of the hands and feet.
Side effects: dyspepsia, headaches, dizziness, urticaria, leukopenia, increased eosinophil levels.
Contraindications: uterine bleeding, low-quality tumors, kidney and liver dysfunction, porphyria (pigment metabolism disorder), problems with cerebral circulation, lactation and pregnancy, systemic lupus erythematosus, changes in blood composition.

Synthetic antimycotics

The prescription of polyene antibiotics (or non-polyene antibiotics) is rare - mainly antifungal drugs in capsules or tablets belong to the group of synthetic antimycotics. It is represented by the following categories of drugs:

azoles;
allylamines;
echinocandins;
drugs from other drug groups (ciclopirox, flucytosine, amorolfine).

Azoles

Broad-spectrum drugs from the azole category have a fungicidal effect (destroy cells) on the fungus if used in high dosages, and fungistatic (prevent proliferation) in low dosages. These medications are also divided into groups (the names of the medications are given for the most commonly used active substances):

Triazole derivatives: miconazole (Daktarin, Klion D), ketoconazole (Oronazole, Nizoral, Fungavis), isoconazole, oxinazole, clotrimazole (Candide, Antifungol), bifonazole, sertaconazole, fenticonazole.
Imidazole derivatives: vorkinazole (Vikand, Vfend), itraconazole (Orungal, Irunit), fluconazole (Diflucan, Flucostat).

Most azole drugs are used in the treatment of mycoses of the scalp, hands and feet, to combat ringworm and especially thrush (vaginal candidiasis), since such tablets are highly effective against the Candida fungus. Among the most popular drugs from the azole group, doctors have identified the most non-toxic and approved during pregnancy, Flucostat:

Active ingredient: fluconazole.
Indications: candidiasis of the mucous membrane of the eye, vagina, internal organs (including prophylaxis during antibiotic treatment), pityriasis versicolor, mycosis of the feet.
Side effects: dizziness, headache, diarrhea, nausea.
Contraindications: hypersensitivity to azoles, age under 3 years, taking hepatotoxic drugs, breastfeeding.

Among other azoles, Mycozoral is considered the strongest (relates to the central component), so it is used mainly where treatment with other antimycotics has not produced an effect. Key points:

Active ingredient: ketoconazole.
Indications: deep mycoses, lesions of the scalp with dermatophytes/moulds, lichen versicolor, chronic superficial candidiasis, systemic infections (histoplasmosis, blastomycosis).
Side effects: menstrual irregularities, toxic hepatitis, loss of appetite, hemolytic anemia.
Contraindications: liver disease, children under 3 years of age, intolerance to any component of the composition. Tablets require care when combined with other medications.

Biflurin tablets (like other drugs containing vorkinazole) are little known; they can be the drugs of choice if you are intolerant to other azoles (or have no effect from them). Features of the drug:

Active ingredient: vorkinazole.
Indications: invasive aspergillosis, severe forms of invasive candidiasis.
Side effects: peripheral edema, chills, fever, chest pain, nausea, vomiting, digestive disorders, anemia.
Contraindications: hypersensitivity, taking rifampicin, barbiturates, efavirenzine, ergot alkaloids.

Allylamines

Elimination of dermatomycosis (on the skin of the body, head) and onychomycosis is the main effect of drugs from the allylamine group, which include only 2 substances: naftifine and terbinafine. Tablets are produced only in the latter and there are a large number of them:

Fungoterbin;
Exifin;
Binafin;
Thermikon;
Mycoferon;
Lamisil.

In the group of allylamines, terbinafine is considered more common and effective: it has a wide spectrum of action and is able to eliminate infections caused by protozoa (leishmaniasis, trypanosomiasis), deep mycoses, and pityriasis versicolor. Naftifine (Exoderil) only works topically. Allylamines act through inhibition of ergosterol synthesis and destruction of the membrane of fungal spores, which leads to the death of the infectious agent. Low dosages are effective against molds and dimorphic fungi. The most famous allylamine is Lamisil:

Indications: dermatophytic onychomycosis, fungal infections of the scalp, foot, legs, candidiasis. With multicolored lichen, the effectiveness is low.
Side effects: headache, dizziness, changes in taste perception, loss of appetite, abdominal pain, urticaria.
Contraindications: hypersensitivity to the composition, chronic/acute liver diseases, renal dysfunction.

Most allylamines have approximately the same spectrum of action due to the same central component in the composition (they differ only in dosages and additional substances, therefore, to replace the expensive (due to its wide popularity) Lamisil, you can purchase a more budget-friendly Thermikon:

Active ingredient: terbinafine.
Indications: mycoses of the scalp (trichophytia, microsporia), skin and nails, severe extensive dermatomycosis of the body, superficial candidiasis (not internal organs).
Side effects: nausea, digestive problems, stool problems, skin allergies, muscle or joint pain.
Contraindications: pregnancy, lactation, alcoholism, inhibition of the hematopoietic process, liver/kidney dysfunction.

Close in cost to Thermikon and Exiter, which, by analogy with all terbinafine tablets, requires careful attention to the instructions, since it can have an effect on the cardiovascular system. Features of the medicine:

Active ingredient: terbinafine.
Indications: mycoses of the skin and nails, candidiasis of the mucous membranes.
Side effects: jaundice, drug-induced hepatitis, muscle, headache or joint pain, nausea, vomiting, skin rash, taste disturbances.
Contraindications: old age, liver/kidney dysfunction.

Echinocandins

A new category of broad-spectrum antifungal agents are echinocandins, presented in a small range. They have not been fully studied by specialists, therefore they are prohibited for patients under 18 years of age, during pregnancy and lactation. Echinocandins work by blocking the synthesis of a fungal cell component, which disrupts the process of its construction. This category contains antifungal drugs only in powder (tablets are not available). The most studied is Cancidas:

Active ingredient: caspofungin.
Indications: candidiasis (strains insensitive to azoles), aspergillosis, suspected fungus in patients with febrile neutropenia (a sharp decrease in the level of neutrophils in the blood).
Side effects: headache, chills, fever, nausea, abdominal pain, diarrhea, anemia, increased bilirubin levels, tachycardia, shortness of breath, skin rash with itching.
Contraindications: age up to 3 months. Persons with liver failure should exercise caution when taking it.

Less well known is the drug Mikamin, which is supposedly even less toxic for children (the instructions do not strictly prohibit its use; the drug can be used for a rash of fungal origin on a child’s buttocks). Most doctors prescribe Mikamin to patients over 16 years of age. Features of the product:

Active ingredient: micafungin.
Indications: prevention or treatment of candidiasis, including candidal stomatitis.
Side effects: leukopenia, anemia, increased eosinophils and bilirubin, hypokalemia, headaches, nausea, diarrhea, abdominal pain.
Contraindications: intolerance to any component of the composition.

Eraxis, in comparison with other echinocandins, is the most budget representative of this group, since 100 ml of lyophilisate costs 5700-6000 rubles. – Mikamin in the same volume will cost the consumer 15,000 rubles. Cancidas is next to it (14,000 rubles for 70 g). Features of Eraxis:

Active ingredient: anidulafungin.
Indications: candidiasis (including damage to the esophagus).
Side effects: allergic skin reactions, bronchospasm, shortness of breath, decreased blood pressure (rare), diarrhea.
Contraindications: sensitivity to any echinocandins.

Other groups

Most dermatologists, when selecting antifungal drugs in tablets or capsules for systemic treatment of an infection, make a choice from the categories presented above. Azoles, allylamines, echinocandins and polyenes cope with most mycoses, but in rare cases it is necessary to turn to drugs from other groups. They have a less wide spectrum of action, but are often not so dangerous to the body. The only drug for systemic intravenous use is Ancotil:

Active ingredient: flucytosine (fluorinated pyrimidine).
Indications for use: has a fungicidal and fungistatic effect against the causative agents of candidiasis, cryptococcosis, chromoblastomycosis (main indications for use), disrupts the synthesis of fungal DNA. For aspergillosis, it is used with amphotericin B.
Contraindications: The drug is non-toxic, prohibited for chronic renal failure and blood diseases. The teratogenic effect was detected only in rats, so the question of using Flucytosine during pregnancy is decided by the doctor.
Side effects: nausea, vomiting, diarrhea, dry mouth, stomach bleeding, headaches, dizziness, acute renal failure, severe weakness, fatigue, allergic reactions, fever.

As an antifungal agent (but not with a wide spectrum of activity), a doctor can also prescribe Potassium iodide, which is available in the form of eye drops and is used externally. The solution is not used orally if there is no iodine deficiency established by the results of the analysis. Before use you need to know:

Active ingredient: potassium iodide.
Indications: lesions of the cornea, pathological conditions of the conjunctiva, which are caused by a fungus.
Contraindications: thyroid tumors, kidney disease, hypersensitivity to iodine (and its excess in the body), acne.
Adverse reactions: increased tearfulness, burning, disruption of the thyroid gland, redness of the mucous membrane of the eyes, deterioration in vision clarity.

What antifungal drugs for internal use are prescribed?

The choice of drug is determined by the specific pathogen, since even broad-spectrum tablets are not absolutely universal. Thus, azoles are mainly used for lichen, onychomycosis, lesions of the scalp, and antibiotics are needed for extensive lesions or systemic infection. Self-selection of an antifungal agent is prohibited, since this can aggravate the situation - the pathogen will mutate and become resistant. To select a medicine, you need to conduct laboratory tests and undergo an examination by a dermatologist.

For deep mycoses

Colonization of bone tissue, nervous system, internal organs, and respiratory tract by pathogenic microorganisms requires the use of immunomodulating drugs. Such severe infections include coccidioidomycosis, cryptococcosis, blastomycosis, and histoplasmosis. Among broad-spectrum antifungal agents, doctors identify polyene antibiotics and some azoles (miconazole, ketoconazole, itraconazole, fluconazole):

Itraconazole is a medicine in capsules; for systemic fungal infections, it is used for 2-12 months (check with your doctor). The exact dosage depends on the specific disease and condition of the patient. Mostly adults are recommended to take 200 mg/day as a single dose.
Ketoconazole DS - dosage is calculated according to the patient’s weight: 30 kg or more - 200-400 mg, less - 4-8 mg/kg. The daily dose is taken once. Used for 4 weeks or longer (as determined by your doctor).

Treatment with intravenous administration of medicinal solutions is considered more effective - polyenes and azoles are also used here. Vorkinazole-Sandoz, the dosage of which is determined individually, was highly praised by doctors. It is worth paying attention to:

Flucorus (fluconazole) – 50-400 mg, frequency of use is 1 r/day. In case of impaired renal function, the dosage is determined individually. The duration of therapy depends on the clinical picture of the disease.
Amphotericin B (or Ampholip) is not a tablet, but a powder for infusion (intravenously), which is given at a frequency of 20-30 drops/min. The adult dosage is 250 units/kg, but for the first use, 100 units/kg is given. The concentration of the solution is 100-125 units per 1 ml of water for injection. Treatment lasts 4-8 weeks with the use of the drug every other day or 2 times a week.

For epidermomycosis

Skin infection requires active local treatment - the use of systemic antifungal agents is considered an additional stage of the main therapy. The non-polyene antibiotic Griseofulvin, synthetic antimycotics based on terbinafine, and Chlornitrophenol are used here. Iodine preparations (potassium iodide) are allowed. Your doctor may recommend the following broad-spectrum antifungal tablets:

For candidiasis

Yeast infection of the genital organs (vaginal thrush), intestines, and oral mucosa is eliminated mainly with the help of 2 categories of antifungal agents with a wide spectrum of activity: polyene antibiotics and azoles. Candidiasis responds to the following medications:

Levorin - adults are recommended to drink 500 thousand units for candidiasis up to 4 times a day. The duration of treatment is 10-12 days.
Nystatin - dosage for adults for candidiasis of internal organs: 500 thousand units with a frequency of 4-8 r/day, therapy lasts 2 weeks. If the infection is generalized, the dose is increased to 6,000 thousand units per day (divided into 4-8 doses).
Clotrimazole - vaginal tablets are used for 3 days, 1 pc. morning and evening or just before bed, but for a whole week. If there is no effect, the doctor must adjust the therapeutic course. If necessary, treatment is extended.
Miconazole - used for intestinal candidiasis in a dosage of 120-240 mg with a frequency of 4 times / day, prescribed for 10-14 days.
Fluconazole (analogue - Diflucan) is the most famous tablet for recurrent thrush, taken 150 mg on the 1st, 4th and 7th day, and then 50 mg weekly for six months.

Severe fungal infections, especially candidiasis of internal organs, require the use of IV solutions. The following broad-spectrum antimycotics have this dosage form:

Fluconazole – 200-400 mg/day, treatment lasts 6-8 weeks. The drip is placed once every day.
Miconazole - with caution, adults are prescribed 10 mg/kg intravenously (a single dose of no more than 600 mg). Dilute the solution with sodium chloride. The duration of use of droppers is determined by the doctor.
Micafungin-Nativ - for esophageal candidiasis, adults are prescribed 150 mg/day intravenously. The number of procedures is set individually.

For the treatment of fungal infections in children

Pediatricians recommend, if possible, using local medications when treating a child, since most broad-spectrum antifungal tablets are toxic. Oral administration is advisable for candidal stomatitis (tablets and lozenges), large lesions for other mycoses and active progression of infection. A doctor should prescribe a therapeutic regimen; do not select such medications for your baby yourself. In children, the following can be used systemically:

Lamisil (terbinafine) - for children over 3 years of age, 125 mg/day (if weight is 20-40 kg) or 250 mg/day (if weight is 40 kg or more). Dosages for tablets and intravenous solution are similar. The course of treatment is individual.
Fluconazole – single use, dose calculated by weight: 6-12 mg/kg, for food candidiasis, once 3 mg/kg. For tablets and intravenous solution, the calculation is the same. Duration of therapy – from 2 weeks.
Amphotericin B - the initial daily dose of the solution is 0.25 mg/kg (diluted with 5% dextrose), gradually increasing it to 1 mg/kg (step - 0.125 mg/kg every other day). Use once a day, the duration of use is determined by the doctor.

Video

Oral candidiasis is a characteristic mucosal lesion caused by a fungal infection of the genus Candida albicans.

The cause of the disease is a general decrease in immunity, which contributes to the proliferation of fungal infections. causes itching and burning in the mouth, as well as other unpleasant symptoms; modern antifungal drugs are used to treat it.

Medicinal complex to combat fungus

Antifungal agents are drugs that have a direct antifungal effect aimed at preventing further growth (fungistatic effect) or completely eliminating the pathogen (fungicidal effect). Antimycotics are prescribed both for the prevention of the disease and for the treatment of all forms.

Modern antimycotics are divided into:

polyene antibiotics, causing destruction of the fungal cell through penetration into its membrane and metabolic disorders (Natamycin, Amphotericin B, Levorin, Nystatin are most effective for candidiasis);
imidazoles, blocking certain enzymes necessary for the functioning of the fungal cell. These include Miconazole, Imidazole and Clotrimazole;
bis-quaternary ammonium compounds(Decamin) also have an antifungal effect and are used both locally on the lesion and in systemic therapy;
echinocandins(Caspofungin, Micafungin) inhibit the synthesis of fungal polysaccharides used to build the cell wall.

Antiseptics are used as rinses to prevent the spread of infection and to sanitize existing foci of inflammation. Such means include solutions and. The mucous membranes are also lubricated with solutions and Resorcinol.

To prevent the disease, vitamin therapy is used to stimulate the immune system, taking into account the replenishment of the deficiency of groups A, C, E, B1, B2, B6.

What you need to know about antifungal agents: pharmacological features, classification, nuances of use:

Products for the treatment of adult patients

The goal of therapy is to simultaneously influence the infection from several points of application. This is a local suppression of infection, the essence of which is the application of antimycotics and other drugs directly to the lesions of the affected oral mucosa, and systemic treatment of candidiasis by taking antibiotics.

Topical products

It begins with the use of medications whose action is aimed at sanitation of the oral cavity. As a rule, aniline dyes can be used for this:

Systemic therapy

For the systemic treatment of candidiasis in adult patients, the following medications are used:

Treatment of children and infants

It is more complex in terms of drug selection; there is only a limited list of approved drugs, among which hydroxyquinoline-8 and -4 derivatives, quaternary ammonium compounds and herbal remedies are used for topical use.

Local effect on fungus

Permitted means include:

Systemic therapy

For systemic exposure the following are used:

Remedies for the treatment of candidiasis of the throat and tonsils

The affected areas of the throat and tonsils must be treated with antiseptic agents moistened with a cotton swab. For this purpose:

Copper sulfate solution. Acts as a disinfectant astringent. Use a solution with a concentration of 0.25%. Treatment of mucosal areas occurs three times a day until the clinical manifestations of the fungal infection completely disappear.
20 % . Apply to areas of the affected mucous membrane of the throat and tonsils to eradicate fungal infections.
. Has the same properties as other solutions.
Resorcinol. A 0.5% solution is used for application to the mucous membrane of the throat. In rare cases, allergic reactions are possible.
Fukortsin solution. May cause temporary local burning and pain. Apply 2 to 4 times a day.
Silver nitrate solution. Has a bactericidal and anti-inflammatory effect. For application to the mucous membranes of the oral cavity, 2% liquid is used.

Local treatment must be accompanied by systemic therapy, which includes the following medications:

Also, for laryngeal candidiasis, physiotherapeutic measures with alternating procedures every two days are effective.

Editor's Choice

Among all the variety of medications, it is difficult to choose the best anti-candidiasis drugs in terms of effectiveness and safety, but we tried to do it. Our TOP 5:

Flucanazole. The drug has a systemic inhibitory effect on the synthesis of biological compounds of the fungal membrane, resulting in its destruction. It has a wide spectrum of action and a low degree of toxicity.
. It does not have accumulative properties in the body, which reduces the risk of side effects. Popular with doctors and patients.
Amphotericin B. Inhibits all types of fungi. Widely used in pediatrics and has almost no side effects.
. The drug can be used in large quantities without the risk of adverse reactions. Interacts with all antifungal drugs.
Ketoconazole. Prescribed for both external and internal use. Its dosage allows you to use the drug once a day.

Any antifungal drugs should be prescribed by the attending physician and only after examination and diagnosis. Thus, when prescribing a particular remedy, the specialist will take into account concomitant diseases, individual susceptibility and the severity of candidiasis.

When taking medications, you must follow the recommended dosage to avoid side effects. Treatment should be comprehensive and consist of several types of therapy (local and systemic).

It must be remembered that treatment must be continued, and its interruption can lead to relapse of the disease. If side effects of any complexity occur, you should contact your doctor to adjust the therapy and eliminate the symptoms that appear.

Candidiasis requires special attention, modern treatment and accurate diagnosis. At the moment, there are many groups of drugs that are individually selected depending on the severity of the disease, concomitant pathologies or existing contraindications.

This type of fungal infection, if the treatment rules are followed, disappears forever, without recurrence or complications.

A large number of fungi live inside and on the human body, which can infect the body during weakened immunity. A fungal infection often affects the skin and nail plates, and less commonly, the hair growth area and internal organs of a person. The advanced form of the disease is difficult to cure, so it is important to start therapy on time.

Antimycotics - what are they?

These tablets are used for systemic therapy of fungal pathologies together with local drugs. The action of antimycotics is antibactericidal - aimed at eliminating pathogenic bacteria and stopping the process of their reproduction. Each broad-spectrum antifungal drug has its own contraindications and dosage. Antimycotics are a class of different chemical compounds that have specific activity against fungal pathogens. Tablets are divided into 2 types:

natural origin;
developed by chemical synthesis.

As cases of infection have become more frequent, the need for antifungal and anti-yeast creams, ointments, solutions and tablets has increased significantly. One of the reasons was the use of strong antibiotics to treat other diseases, which disrupt the intestinal microflora and reduce the body's protective functions. In addition to this classification, depending on the chemical structure, zone of activity, and clinical use for various forms of mycoses, broad-spectrum antifungal drugs are divided into several types.

Active ingredient of antifungal drugs

Broad-spectrum agents have fungistatic and fungicidal effects. Thanks to this, antifungal tablet drugs are able to create suitable conditions for the destruction of fungal spores. Due to the fungistatic effect of antimycotics, the proliferation of pathogenic bacteria throughout the body is suppressed (fungi live in all body fluids).

The active substance contained in the capsules, when it enters the gastrointestinal tract, is absorbed directly into the blood and spreads throughout the body, destroying fungal spores. The active component remains in the body for a long time and is then excreted in the urine. Each group of antimycotic tablets has an individual mechanism of action, which is determined by the set of active ingredients:

drugs with ketoconazole stop the synthesis of the constituent substances of the fungal cell membrane;
products containing itraconazole inhibit the formation of ergosterol, an important component of the fungal cell;
tablets with fluconazole suppress the synthesis of fungal spores and eliminate existing ones;
drugs containing terbinafine block the synthesis of ergosterol at an early stage;
products containing griseofulvin prevent the division of fungal cells.

How to take pills correctly

Patients prescribed antifungal drugs in broad-spectrum tablets must strictly follow the treatment regimen. It is forbidden to interrupt therapy on your own or skip taking the next capsule - this doubles the risk of relapse of the disease. In addition, to achieve the most effective treatment, broad-spectrum tablets should be taken at the same time. If for certain reasons the next dose of the drug was missed, you need to take the drug at the first opportunity (do not double the dose).

Antifungal medications should be taken with food and with plenty of water. A patient with low acidity is prohibited from taking broad-spectrum antifungal tablets of the azole group. If the patient has been prescribed such drugs, they should be taken with oxidizing liquids (orange juice, etc.). Pregnant and lactating girls are prohibited from taking azole antifungal tablets.

Classification of antifungal drugs

Modern medicine identifies about five thousand different fungi that can provoke mild and severe mycoses in humans. Fungal pathologies are divided into:

superficial (affect nails, hair, skin);
internal (harm organs and systems).

To treat mycoses, antifungal drugs in broad-spectrum tablets or local antimycotics are used. Before prescribing oral medications, the doctor determines the type of fungus that has infected the human body. Based on tests (smear of the throat mucosa, removal of skin flakes, etc.), an effective drug is selected and the appropriate dosage is established.

Azole group

These antifungal drugs are among the synthetic antimycotics. Azoles are effective against several types of lichen, fungi of nails, skin, hair, intimate and other candidiasis. Tablets of this group have a fungistatic effect and are very effective against the pathogen Candida. Azole names:

Ketoconazole(analogues are Mycozoral, Fungavis, Oronazole);
(analogues: Diflucan, Mikomax, Flucostat);
(its analogues: Orungal, Orunit, Irunin, etc.).

Polyene antifungal drugs

This group of antifungal agents has the widest possible spectrum of action. Polyenes are active primarily against candidiasis, but some members of the group effectively eliminate other protozoa, including Trichomonas. Polyene preparations do not act on dermatomycete fungi and pseudoallesheria. These tablets are prescribed for the treatment of candidiasis of the skin, mucous membranes (stomatitis, thrush, etc.), and the gastrointestinal tract. Antifungal drugs in broad-spectrum tablets of the polyene group are:

Allylamine group

These are synthetic antifungal agents that are necessary for the treatment of fungal pathologies of nails (onychomycosis), hair, skin, and lichen. Allylamines have a wide spectrum of action and actively destroy the membranes of fungal spores. In low dosages, the tablets act on dimorphic and mold fungi. Allylamines include:

Exittern.

What pills to take for fungus

The choice of medicines for fungus is made exclusively by a doctor, who takes into account the clinical picture of the disease and the general health of the woman or man. Unauthorized termination of therapy or replacement of antifungal drugs in broad-spectrum tablets with other medications is prohibited. Below is a rating of effective antifungal agents for the treatment of different types of mycoses.

Antifungal drugs for body skin

Dermatomycosis is a frequently diagnosed disease that affects the skin of the head, legs, arms, abdomen, and other parts of the body. There are many antifungal drugs aimed at eliminating skin mycosis, among them the best are:

Nystatin. The medication is used to treat not only skin fungus, but also candidiasis of the vagina, mouth, and intestines. The drug is taken 3-4 times a day, 1 tablet. The doctor selects the dosage for the child individually.
Fluconazole. Prescribed for candidiasis of various organs, including the skin. The second generation antimycotic has a negative effect on the liver, but after completion of treatment the organ is restored. The recommended daily dosage is 150 mg weekly (taken 2-3 times in total). Find out more.
Itraconazole. Capsules are prescribed for the treatment of skin mycoses, candidiasis, and onychomycosis. The drug is suitable for the prevention of the listed pathologies in people with HIV. The recommended daily amount of a broad-spectrum agent is 200 mg (the course lasts a week).
. Can be used for the treatment of fungus, lichen, trichomoniasis. These inexpensive but effective tablets are taken as prescribed by a doctor, who individually selects the dosage. The course of treatment is at least a week.
Ketoconazole. Tablets are widely used for the treatment of seborrheic dermatitis and dermatomycosis. The product is contraindicated during pregnancy and breastfeeding. The doctor prescribes Ketoconazole at a dosage of 200 mg per day, determining the duration of administration individually for each patient.

Tablets for candidiasis

Having diagnosed a mild degree of thrush, the doctor prescribes topical tablets. For the treatment of acute forms of candidiasis, it is necessary to take a wide range of drugs. Treatment lasts on average 2 weeks. As a rule, a gynecologist prescribes one of the following remedies for the treatment of thrush:

. Due to its mild action, the drug can be used even during pregnancy and breastfeeding. Pimafucin does not provoke allergic reactions and is well tolerated. Thrush tablets contain natamycin and are non-toxic.
Clotrimazole. Effective for the treatment of vaginal candidiasis, but not suitable for oral use during pregnancy or breastfeeding.
Diflucan. As a rule, a single dose of an antifungal drug is enough to treat thrush. Contraindications for Duflocan: pregnancy, lactation, chronic kidney and liver pathologies.

Antimycotics for nail fungus

The initial stage of development of onychomycosis is successfully treated with local means: solutions, ointments, special varnishes, gels. If the disease has affected a large part of the nail plate, you cannot do without broad-spectrum tablets. The doctor selects the appropriate medication based on the degree of the disease. The most effective antifungal drugs for toenails are:

Fluconazole (price – 25-50 rubles);
Ketoconazole or (about 500 rubles);
Itraconazole (RUR 2,500);
(about 200 rub.);
Terbinafine (up to 2000 rubles).

Video: how to treat mycoses

Despite the constantly 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 medications, but for successful treatment it is necessary to use only high-quality and effective antifungal drugs from the list of the best drugs.

Combining quality and effectiveness does not always mean purchasing super-expensive medicines. There are quite a few inexpensive anti-fungal drugs that are highly effective and quick-acting. In addition, when treating fungus, you can use analogues of expensive drugs that give the same result as the original drug.

Differences and features of antifungal drugs

Anti-fungal drugs are selected depending on the duration of mycosis, the volume of the affected surface, the presence of concomitant diseases, and the nature of the fungal manifestations.

The forms of release of antifungal agents are varied - they are available in the form of tablets, ointments, gels, solutions, suppositories. The variety of release forms allows you to treat not only external forms of mycosis (feet, genitals, toenails and fingernails), but also 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 makes it possible to successfully treat fungal diseases of any nature

Note! Therapy with one 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 for the fungus.

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

When to use antifungal drugs:

Mycosis of the foot;
Yeast skin infection;
Cryptococcosis;
Fungal infections of the respiratory tract, eyes;
Vaginal;
Paracoccidioidomycosis;
Histoplasmosis;
Athlete's foot in the groin area;
Yeast skin infection;
Candidemia;
esophagus and oral cavity;
Sporotrichosis;
Fungus of the scalp;
Diaper rash;
Body skin fungus.

Therapeutic agents against fungus are aimed at killing and destroying the causative agents of the disease, and stopping the spread of infection. Some of the drugs successfully defeat dermatophytes (molds), 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.

Review of antifungal drugs

Anti-fungal drugs are classified depending on their chemical structure, clinical purpose and spectrum of action. The most common and effective medicinal 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, and 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, and oral cavity. It has practically no contraindications; side effects in the form of allergic reactions are possible. The course of treatment lasts from 10 to 14 days (according to the instructions). Price – from 40 rub.
Levorin - used for candidiasis of the gastrointestinal tract and skin, has high activity against trichomonas, Candida fungi, and leishmania. Not allowed for use during pregnancy, under the age of 2 years, during lactation, with hepatic and, intestinal and stomach ulcers. Price – 100-130 rubles.
Pimafucin - has an effect on a huge number of pathogenic fungi that infect the body. Prescribed for candidiasis of the gastrointestinal tract, vagina, to remove the effects of taking antibiotics and corticosteroids. Price – from 250 rub.

Azole group

Azoles are synthetic drugs used in the treatment of mycoses of the scalp, skin, toenails and hand nails. 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, and chronic candidiasis. Often used for skin and treatment of scalp fungus, if there is a high degree of damage and resistance to infection. The drug can cause extensive side effects and should be used with caution in children and elderly patients. Price – from 100 rub.
Mycozoral is an ointment for the treatment of epidermophytosis, pityriasis versicolor, seborrheic dermatitis, dermatomycosis, and various types of candidiasis. 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 rub.
Sebozol is a drug in the form of a shampoo ointment used against yeast-like fungi, dimorphites, etc. Used to treat fungal infections of the feet, nails, scalp, and hands. Price – from 130 rub.
Fluconazole - has a wide range of effects against infections by Cryptococcus fungi, candidiasis of the oral cavity and pharynx, respiratory system, reproductive system, nail fungi, and lichen. Capsules are used with caution during pregnancy and for pathological diseases of the liver and heart. Price – from 20 rub.

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

Allylamine group

The drugs in this series actively fight against dermatomycosis - fungal infections of the hair, skin, and 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. Prescribed for severe fungal infections of the nails, feet, head, and torso. Price – from 48 rub.

The active substance terbinafine destroys 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 makes it possible to use products based on it for the treatment of mycoses in pregnant women and children.

Inexpensive antifungal analogues

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

Generics have their own name for the drug, but you can determine which analogue they are by looking at the active ingredient of the drug, which is prescribed on the package.

Terbinafine, one of the most effective antifungal drugs, has the following analogues:

Terbizol;
Binofin;
Fungoterbin;
Exifin;
Lamican.

The active substance fluconazole is contained in the following preparations:

Futsis;
Diflucan;
Nofung;
Mikosist;
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 effectiveness of drugs. The most inexpensive analogs are found in a series of drugs based on ketoconazole and fluconazole. Analogues of terbinafine occupy a middle position, and the most expensive are drugs based on itraconazole (Itramikol, Irunin, Itrazol, Canditral).

Antifungal drugs for children

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

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

If a child has candidiasis, they are prescribed medications in the form of tablets or lozenges. Treatment of 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:

Mikozan;
Nystatin;
Amorolfine.

Systemic therapy is carried out only if large lesions occur and spread rapidly. 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. Only a qualified doctor can draw up the correct treatment plan.