Medical Microbiology

GeneralAspectsofFungalDisease 357

&Azoles.Theseagentsdisruptergosterolbiosynthesis.Theireffectismainly

fungistaticwithpossiblegastrointestinalsideeffects.Hepaticfunctional

parametersshouldbemonitoredduringtherapy:

— Ketoconazole.Oneofthefirstazoles.Nolongerusedbecauseofside

effects.

— Fluconazole.Oralorintravenousapplication.Forthetreatmentofsurface

andsystemicmycosesandcryptococcalmeningitisinAIDSpatients.

— Itraconazole.Oralandintravenousapplication.Useinsystemicandcuta-

neousmycosesandalsoforthetreatmentofaspergillosis.

— Voriconazole.Oralandintravenousapplication.Goodactivityagainst

CandidaandAspergillus.NoacitivityagainstMucorales.

&Antimetabolites.5-Fluorocytosine.InterfereswithDNAsynthesis(base

analog).Givenbyoralapplicationincandidiasis,aspergillosis,andcryptococ-

cosis.Itisnecessarytomonitorthecourseoftherapyforthedevelopmentof

resistance.ThetoxicityofamphotericinBisreducedincombinationwith5-

fluorocytosine.

&Allylamines.Terbinafine.Byoralandtopicalapplicationtotreatderma-

tomycoses.Inhibitionofergosterolbiosynthesis.

&Echinocandins.Caspofunginhasbeenapprovedasasalvagetherapyin

refractoryaspergillosis.Itisusefulalsoinoropharyngealandesophagealcan-

didiasis.Inhibitionofthebiosynthesisofglucanofthecellwall.

&Griseofulvin.Thisisanolderantibioticusedintreatmentofdermatomy-

coses.Byoralapplication,therapymustoftenbecontinuedformonths.

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Kayser, Medical Microbiology © 2005 Thieme