Antifungal medicines

What are antifungal medicines and how do they work?

There are several types of antifungal medicines. They come as creams, sprays, powders, 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 medications 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 containing 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.

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.

Side-effects of antifungal medicines

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

Antifungal creams

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 mild 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 possible side-effects of some of the more widely used antifungal medicines are:

• • Terbinafine sometimes causes tummy ache, loss of appetite, feeling sick (nausea), tummy upset, diarrhoea, headache, rash, taste disturbance and muscle or joint pain.

  • 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 carry a higher risk of side-effects and sometimes cause serious problems. However, they are used to treat severe 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. Sometimes a longer course of treatment is necessary.

• 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 antifungal creams without a problem: if in doubt, take advice from your pharmacist or doctor.

• Antifungal pills are stronger than the creams and can possibly interact with other pills you are taking. You must check with a pharmacist or 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 can use the antifungal creams.

Can I buy antifungal medication?

Yes - there a number of antifungal creams you can buy from your pharmacy (for example, clotrimazole and terbinafine). You can also buy oral fluconazole to treat vaginal thrush.