Antifungal Medications: What You Should Know

There are millions of types of fungi, including yeasts and molds. While these fungi occur naturally in many places—and some within our bodies—they rarely cause severe disease. Some conditions that weaken the immune system might make you more susceptible to these kinds of infections and require treatment using antifungal medications.

There are several types of antifungal medications, and this article will explore the different varieties, when they might be used, and what to expect while taking them.

What Are Antifungal Medications?

Antifungal drugs are a class of medications that are used to treat invasive fungal infections. There is a wide range of types, strengths, formulations, and uses for the medications in this class.

Each of these medications works by killing fungi causing infection and/or stopping the fungi from continuing to grow.

How They Work

Each type of antifungal works in a different way. Certain antifungals target specific types of fungus, while others can be used on a wide range of species. Typically, these medications work in one of the following ways:

• By destroying or damaging the outer wall or membrane of a fungus cell
• By preventing the fungal cells from growing or reproducing

Types of Antifungal Medications

There are four main types of antifungal medications. They each work in a specific way to treat certain types of fungal infections.

Allylamines

Antifungal medications in this group attack the membranes of fungal cells, eventually destroying them. This type of medication can treat a variety of fungal infections of the skin, nails, and hair.

There are two main formulations of allyamines—Lamisil (terbinafine) and Naftin (naftifine).

Azoles

Azoles are a type of antifungal that many people are familiar with. These medications attack the cell membrane and keep fungi from growing. Antifungal medications in the azole family are usually used to treat candidiasis, a fungal infection caused by yeast. This can include conditions such as vaginal yeast infections, athlete's foot, and jock itch.

Examples of medications found in the azole category include:

• Nizarol and Xolegel (ketoconazole)
• Monistat and Micatin (miconazole)
• Lotrimin and Mycelex (clotrimazole)
• Sporanox (itraconazole)
• Cresemba (isavuconazonium sulfate)
• Diflucan (fluconazole)
• Vfend (voriconazole)
• Noxafil (posaconazole)

These medications are available in different strengths, including some that can be purchased over the counter and others that require a prescription. Azoles are also usually offered in a variety of formulations from powders to creams.

Although these antifungals are very useful, their popularity has led to a level of resistance.

Additionally, there are some types of fungus that don't respond to certain antifungals. In many cases, it's best to consult a healthcare professional if you are unsure which antifungal is the right choice for your symptoms. You may be recommended a different antifungal than what you are using, or a product that combines more than one type of antifungal medication in a single application.

Echinocandins

This is a newer type of antifungal that damages and destroys the cell wall of the fungus. While there are few adverse reactions with other medications and limited side effects with this antifungal, it's only available as a daily intravenous treatment. Antifungals in this group are usually used to treat invasive candidiasis.

Examples of medications in this group are:

• Caspofungin
• Anidulafungin
• Micafungin

Polyenes

Polyenes are produced naturally by the bacterium Streptomyces nodosus. These compounds work by damaging the fungal cell membrane, allowing potassium to spill out of the cell. This eventually leads to death of the fungal cell and an end to the fungal infection.

Amphotericin B is one formulation in this class, and it's one of the most potent antifungals. Medications in this class are often used in systemic infections, which are fungal infections that impact the entire body.

These types of antifungal medications are typically used to treat infections like:

• Aspergillosis
• Blastomycosis
• Candidemia
• Coccidioidomycosis
• Histoplasmosis

Examples of this type of antifungal include:

• Ambisome and Abelcet (amphotericin b)
• Mycostatin, Nyamyc, and Nystop (nystatin)

Use of this class can be limited by a lack of oral formulas and the risk of serious side effects like kidney damage.

Types of Fungal Infections

While nail, vaginal, skin, and oral fungal infections are most common, there are many other ways a fungal infection can appear. People with certain conditions or who take medications that suppress the immune system are more prone to developing fungal infections, as are people who live in tropical climates.

Some common fungal infections that are specific to location are:

• Blastomycosis: Found in the soil in parts of the United States and Canada
• Cryptococcus gattii: Found in tropical and subtropical areas, as well as the Pacific Northwest and British Columbia
• Paracoccidioidomycosis: Found in Central America and South America, and mostly affects men who work outdoors in rural areas
• Coccidioidomycosis: Also known as Valley fever and caused by a fungus that can be found in the southwestern United States, Mexico, and parts of Central America and South America
• Histoplasmosis: Widespread but mostly associated with bird or bat droppings

Other types of fungal infections are most common with people whose immune systems are weakened by a disease or medications like chemotherapy or steroids. Examples of these infections are:

• Aspergillosis: An infection caused by a common mold found indoors and outdoors
• Candida auris: A newer fungus found mostly in healthcare settings
• Invasive candidiasis: A serious infection affecting areas like the heart, brain, eyes, and bone that are common in hospitalized patients
• Pneumocytis pneumonia: A serious infection of the lungs caused by Pneumocystis jirovecii that is most common in people with human immunodeficiency virus (HIV) and AIDS
• Candidiasis: A fungal infection caused by yeasts that are normally found on the skin and in the body but don't become a problem until they grow out of control
• Cryptococcus neoformans: A fungal infection that affects the brain and can lead to meningitis
• Mucormycosis: A rare fungal infection caused by molds called mucormycetes
• Talaromycosis: An infection caused by a type of fungus found in Southeast Asia, southern China, and eastern India
  

Symptoms

Symptoms of fungal infections vary depending on the type of fungus causing the infection and what body system is being affected.

Skin

There are many types of fungal infections that affect the skin. Exact symptoms may vary, but may include:

• Itching
• Redness
• Rash
• Hair loss
• Dry or scaly areas

Nails

When fungal infections impact the nails, they may become:

• Thick
• Brittle
• Fragile
• Discolored

Groin

Another common area for fungal infections is the groin. This can come in the form of a vaginal yeast infection or jock itch. In both cases, symptoms include itchiness and irritation but vaginal yeast infections may also lead to pain during urination and thick or foul-smelling discharge. Jock itch, on the other hand, usually has more superficial symptoms like skin flaking or redness.

Oral

When yeast infections develop in the mouth, throat, or esophagus, these are called thrush. You may experience a wide range of symptoms that include:

• White patches inside the mouth or throat
• Redness
• Soreness
• Pain when eating or swallowing
• Loss of taste
• Cracking or redness at the corners of your mouth
  

When to Contact a Healthcare Provider

Most fungal infections cause minor or superficial symptoms like itching, redness, or general discomfort. However, when fungal infections become systemic—affecting the entire body—symptoms can become more diverse and mimic a number of other conditions.

Symptoms of systemic fungal infections include:

• Tiredness
• Difficulty breathing
• Muscle aches
• Joint pain
• Night sweats
• Weight loss
• Chest pain
• Fever

If you have any of these symptoms and they are not going away, or if your fungal infection isn't clearing with the use of over-the-counter (OTC) antifungal medications. Your doctor may need to investigate your symptoms to rule out other infections, or prescribe a stronger antifungal medication for you.

Summary

There are thousands of types of fungus that can lead to a wide range of infections and symptoms. Antifungal medications can kill fungus cells or stop them from growing, but it's important to know which medications are best to treat which types of fungal infection. Even when you are using the right form of medication, it can take weeks to months to clear fungal infections completely.

A Word From Verywell

Fungal infections rarely cause severe illness, but they can be irritating and uncomfortable. There is a wide variety of OTC treatments for fungal infections like jock itch or athlete's foot, but other fungal infections may require prescription treatment.

If you are treating what you believe is a fungal infection at home and your symptoms become worse or don't improve over time, you should see a healthcare provider for additional testing and treatment.