Classification and difference of super classic and super new antifungal drugs! (Worthy of collection)

Author: Gcplive

Source: Center for Drug Evaluation

With With the extensive use of antibiotics and immunosuppression, as well as the extensive development of organ (bone marrow) transplantation and medical invasive procedures, the incidence of deep fungal infection (invasive fungal infection) continues to rise, and the rational use of antifungal drugs more and more important. Today focuses on antifungal drugs for invasive fungal infections. I. Systemic antifungal drugsnystatin Treatment of gastrointestinal candidiasis. Terbinafine, griseofulvin, orally used primarily for superficial fungal infections (skin, hair, and nails). Second, the mechanism of action of antifungal drugsFungal cell wall synthesis inhibitor. /span>β-(1,3)-D-glucan is one of the main components of fungal cell walls. Acanthins (micafungin, caspofungin) exert antifungal effects mainly by inhibiting the synthesis of β-(1,3)-D-glucan. Because human cells have no cell walls, echinocandins are relatively nontoxic. 2. Inhibitors of cell membrane stabilityPolyenes (Amphotericin B, Nystatin) by interacting with The combination of ergosterol on the fungal cell membrane damages the permeability of the cell membrane and exerts an antifungal effect. The antifungal effect and toxicity of amphotericin B were related to damage to cell membrane. Fortunately, amphotericin B binds ergosterol on fungal cell membranes 500 times more strongly than cholesterol on human cell membranes. 3. Ergosterol synthesis inhibitors4. Selection of antifungal drugsFluconazole, voriconazole and flucytosine can pass through the blood-brain barrier. The amount of fluconazole and flucytosine excreted through the kidneys in the original form was more than 80%. The amount of itraconazole, voriconazole, posaconazole, isavuconazole, micafungin, and caspofungin excreted through the kidneys was less than 2%. Clinical selection of antifungal drugs is mainly based on antimicrobial spectrum, pharmacokinetic characteristics, and severity of infection. For example:1. Invasive pulmonary aspergillosisVoriconazole is the first choice, and the alternative is moxa saconazole. 2. CandidiasisBloodstream infection: preferred kappa Fenkin or Micafungin. Urinary tract infection: Fluconazole is the first choice, and amphotericin B is the alternative (Fluconazole is mainly excreted unchanged through the kidneys). 3. CryptococcosisNon-meningitis: Flucon is preferred azole, and amphotericin B in severe cases. meningitis: amphotericin B + flucytosine, and fluconazole is used for maintenance (flucytosine and fluconazole can enter the cerebrospinal fluid) . 4. MucormycosisAmphotericin B is the first choice, and isavuconazole is the alternative.