Antifungal Medicines

What are antifungal medicines and how do they work?

There are several types of antifungal medicines. They come as creams, sprays, solutions, tablets designed to go into the vagina (pessaries), shampoos, medicines to take by mouth, and injections. Most work by damaging the cell wall of the fungus, which causes the fungal cell to die.

Antifungal creams, liquids or sprays (also called topical antifungals)

These are used to treat fungal infections of the skin, scalp and nails. They include clotrimazole, econazole, ketoconazole, miconazole, tioconazole, terbinafine, and amorolfine. They come in various different brand names.

Sometimes an antifungal cream is combined with other creams when two actions are required. For example, an antifungal cream is often combined with a mild steroid cream, such as hydrocortisone, to treat certain rashes. The antifungal cream clears the infection, and the mild steroid cream reduces the inflammation caused by the infection.

There are also separate leaflets in this series that deal with Candidal Skin Infection (Yeast Infection), Fungal Scalp Infection (Scalp Ringworm) and Fungal Nail Infections (Tinea Unguium).

Antifungal shampoo

A shampoo which contains ketoconazole is sometimes used to help treat scalp fungal infections and certain skin conditions.

Antifungal pessaries

Pessaries are tablets which are designed to be put into the vagina. Some antifungal medicines are used as pessaries to treat vaginal thrush, particularly clotrimazole, econazole, miconazole, and fenticonazole

Antifungal medicines taken by mouth

There are various types. For example:

Miconazole is available as an oral gel, and nystatin as a liquid. They are applied to the mouth. They are used to treat thrush (candidal infection) of the mouth and throat.

Terbinafine, itraconazole, fluconazole, posaconazole, and voriconazole are available as tablets, which are absorbed into the body. They are used to treat various fungal infections. The one chosen depends on what type of infection you have. For example:

• Terbinafine is commonly used to treat nail infections which are usually caused by a tinea type of fungus.
• Fluconazole is commonly used to treat vaginal thrush, as an alternative to using antifungal cream. It is also used to treat and prevent certain fungal infections within the body.

There are also separate leaflets in this series dealing with athlete's foot, ringworm and fungal groin infection.

Antifungal injections

These may be used if you have a serious fungal infection within the body. Amphotericin, flucytosine, itraconazole, voriconazole, anidulafungin, caspofungin, and micafungin are medicines that are sometimes used in this way. The one chosen depends on the type of fungus causing the infection. These are specialist medications that are used for people who are usually quite ill in hospital.

Note: antifungal medicines are different to antibiotics, which are antibacterial medicines. Antibiotics do not kill fungi - they kill other types of germs (called bacteria). In fact, you are more prone to getting a fungal infection if you take antibiotics. For example, many women develop thrush after taking a course of antibiotics. This is because the antibiotic may kill the normal harmless bacteria that live on your skin or vagina and make it easier for fungi to flourish.

There are several types of antifungal medicine

What are the possible side-effects of antifungal medication?

You should read the information leaflet that comes with your particular brand for a full list of cautions and possible side-effects. As a general rule:

• Antifungal creams, sprays, liquids and shampoos. These usually cause no side-effects and are easy to use. Occasionally some people get a little bit of itch, burning or redness where the antifungal preparation has been applied. If this is severe, you should stop using it. Occasionally, some women develop irritation around the vagina after applying vaginal antifungal products.
• Antifungal medicines by mouth. The most widely used are terbinafine for nail infections, miconazole, and nystatin for oral thrush, and fluconazole for vaginal thrush. These usually cause no side-effects. You can even buy fluconazole without a prescription at pharmacies, as it is considered a medicine which is unlikely to cause problems. Some antifungal preparations cause liver problems or more serious side-effects in a small number of people. A few common possible side-effects of some of the more widely used antifungal medicines are as follows:
• Terbinafine sometimes causes tummy aches, loss of appetite, feeling sick (nausea), tummy upsets, diarrhoea, headache, rash, taste disturbance and muscle or joint pains.
• Fluconazole may cause nausea, tummy ache, diarrhoea, wind, headache, or a rash.
• Miconazole may cause nausea or sickness (vomiting), or a rash.
• Nystatin may cause soreness of the mouth.
• Antifungal injections. These have more risk of causing side-effects and sometimes serious problems. However, these are used to treat serious fungal infections and the risk of side-effects needs to be balanced against the need for treatment.

What is the usual length of treatment with antifungal medication?

• Fungal skin infections like athlete's foot or ringworm: a cream is usually used for two weeks as a minimum. Sometimes up to six weeks' treatment is needed with a cream.
• Fungal nail infections: if taking an antifungal pill like terbinafine, treatment is usually used for two months.
• Fungal infections in lungs: this is a more serious condition and the duration of treatment will be decided by a specialist in that field.
  

Who cannot take or use antifungal medication?

• Generally everybody can use the antifungal creams without a problem: if in doubt, take advice from your doctor.
• The antifungal pills are stronger than the creams and can interact with any other pills you are taking. You must check with a doctor before taking an antifungal pill, if you take other medicines.
• Generally young children should not take antifungal tablets, but are OK to use the creams.
• Elderly people should ask their doctor before using an antifungal pill, but are generally fine to use the antifungal creams.

Can I buy antifungal medication?

Yes - there a number of antifungal creams you can buy at your pharmacy (for example, clotrimazole, and terbinafine). In addition, you can also buy oral fluconazole from your pharmacy, to treat vaginal thrush. Be aware though that if you use the wrong cream then it can make fungal skin infections worse. For example, steroids should not be used on athlete's foot: only terbinafine cream by itself. If you put steroid cream on athlete's foot it usually makes it worse.