Topic overview

Start with the big picture

Antifungal agents act on distinct fungal targets: polyenes bind ergosterol and disrupt membranes, azoles inhibit ergosterol synthesis, and echinocandins block β-1,3-glucan synthesis. Other options include flucytosine, allylamines, and griseofulvin. Clinical selection varies by infection: echinocandins are used for bloodstream Candida, voriconazole for invasive Aspergillus, and amphotericin B with flucytosine for induction treatment of cryptococcal meningitis. Azoles have roles across several infections, including fluconazole for Candida and itraconazole for histoplasmosis or blastomycosis. Important safety considerations include amphotericin-associated nephrotoxicity, flucytosine-associated myelosuppression, and potential liver effects with several agents. These principles provide a framework for matching drug class, organism, and disease severity.