Drug therapy reviews: Clinical pharmacology and therapeutic use of antimycotic drugs

Abstract

Indications, pharmacology, mechanism of action, adverse reactions, administration and dosage ot SIX antimycotic drugs (amphotericin B, flucytosine, nystatin, clotrimazole, miconazole nitrate and griseofulvin) are reviewed. The availability and cost of commercial preparations are listed. Amphotericin B is the single most effective drug against the following systemic fungal infections: blastomycosis, histoplasmosis, cryptococcosis, candidiasis, sporotrichosis, aspergillosis, mucormycosis and coccidioidomycosis. Some Candida sp are sensitive to flucytosine, but the drug IS useful only occasionally in the treatment of systemic candidal infections. Flucytosine may be effective in the treatment of Aspergillus pneumonia and meningitis, hut this drug alone is not the best treatment. Nystatin has been used topically to treat superficial candidal infections of the oral mucosa (thrush) and esophagus, and candidal stomatitis, pharyngitis and vaginitis; aerosols have been used to treat systemic aspergillosis and candidiasis. Clotrimazole. IS useful topically for Candida, Tricophyton or Microsporum skin infections, and vaginally tor vaginal candidiasis. Intravenous miconazole is used most commonly against Coccidioides immitis infections involving pulmonary, osseous and meningeal sites; topically, miconazole has the same Uses as clotrimazole. Griseofulvin is most effective for tinea and ringworm infections caused by Tricophyton sp and Microsporum sp. No other antiinfective drug causes toxic reactions as often as amphotericin B; however, the drug does have unique uses that often outweigh its risks. Flucytosine may depress the bone marrow and cause leukopenia, neutropenia and thrombocytopenia. Nystatin causes few adverse reactions; systemic absorption is minimal. There are few side effects with topical use of Clotimazole. Phlebitits often occurs after i.v administration of miconazole nitrate. Griseofulvin produces few adverse effects