Antifungals

See also Antifungal spectrum of activity

Polyenes

• Mechanism: bind to ergosterol in the cell membrane and create pores
• Examples: Amphotericin B

Triazoles

• Mechanism: inhibit 14-alpha demethylase (aka. Cyp51p, encoded by Erg11 genes), which is required for synthesis of ergosterol from lanosterol, thus disrupting the cell wall.
• Examples
  • Fluconazole: Used as prophylaxis or treatment for Candida
  • Voriconazole: First-line treatment for invasive aspergillosis
  • Itraconazole
  • Posaconazole: Second-line treatment for invasive aspergillosis, but first-line for prophylaxis
  • Isavuconazole

Echinocandins

• Mechanism: disrupt synthesis of beta-glucan in the cell wall by inhibiting 1,3-beta glucan synthase
• Examples
  • Micafungin
  • Caspofungin: Febrile neutropenia
  • Anidulafungin: ICU (high APACHEII), no renal or hepatic dosing needed