Oral antifungal medications
Oral antifungal medications may be required for a fungal infection if:
- It is extensive or severe.
- It resists topical antifungal therapy.
- It affects hair-bearing areas (tinea capitis and tinea barbae).
The choice of oral antifungal medication, its dose and the duration of treatment depends on:
- The type of fungus i.e. candida, dermatophyte (tinea), malassezia, or mould.
- The site affected i.e. skin, mucosa, nails.
- Other co-existing diseases.
- Interactions with other medications.
Medications for both candida and dermatophyte infections (azoles)
The trade names of the medications sold in New Zealand are given in parentheses.
- Itraconazole (Sporanox® capsules).
- Ketoconazole (Nizoral® tablets).
- Fluconazole (Diflucan® capsules).
Voriconazole IVfend® tablets) and posaconazole are reserved for serious invasive Candida and mould infections.
Some species of candida are resistant to azoles, and azole resistance is increasing especially in immunosuppressed patients who are prescribed long courses.
Medications only suitable for candida infections
- Nystatin (Mycostatin®, Nilstat®), a polyene. This is not absorbed into the blood stream through the gut.
- Flucytosine (Alcobon® infusion), usually used with amphotericin. It can cause bone marrow depression.
- Amphotericin B (Ambisome® injection; Fungizone® infusion), a polyene. This is not absorbed into the blood stream through the gut.
- Caspofungin, anidulafungin and micafungin (echinocandins)
Medications only suitable for dermatophyte infections
- Griseofulvin (no longer available in New Zealand), derived from Penicillium
- Terbinafine (Lamisil®, Terbafin® tablets), an allylamine.
On DermNet NZ:
- Consumer medicine information – Medsafe
- Medicine data sheets – Medsafe
- Drugs, Herbs and Supplements – MedlinePlus
Books about skin diseases:
See the DermNet NZ bookstore
New Zealand approved datasheets are the official source of information for these prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.