4Amphotericin BProduced by Streptomyces nodosus. Amphoteric polyene macrolide.Pharmacological Effect: broad-spectrumMechanism: binds to ergosterol in fungi (cholesterol in humans and bacteria) to form pores
5Pharmacokinetics: Poorly absorbed from the gastrointestinal tract. More than 90% bound by serum proteins.Metabolized in liver, excreted slowly in the urine.
6Adverse Effects:Infusion-Related Toxicity: fever, chills, muscle spasms, vomiting, headache, hypotension.Slower Toxicity:Renal toxicityK+↓, Mg2+↓Anemia: erythropoietin (促红细胞生成素)↓Abnormalities of liver functionNeurologic sequelaAnnouncements:Administration in advance of NSAIDs and Antihistamine drug, GlucocorticoidPeriodic Monitoring
7Liposomal Amphotericin B Lipid preparations reduce toxicity without sacrificing efficacy.Lipid formulations distributes mostly in reticular endothelial tissue (liver, spleen, lung), but less in kidney.
8Nysfungin Like Amphotericin B and has same mechanism of action. Too toxic for parenteral administration, and is only used topically (局部).Not absorbed from skin, mucous membranes, or the gastrointestinal tract, so little significant toxicity.
9Griseofulvin Derived from a species of penicillium. Fungistatic drug (抑菌剂).Insoluble.Administered in a microcrystalline form only using in the systemic treatment of dermatophytosis (脚癣).Deposited in newly forming skin where it binds to keratin (角蛋白), protecting the skin from new infection.
10Azoles Synthetic compounds. Classification: according to the number of nitrogen atoms in the five-membered azole ringImidazoles: Ketoconazole, Miconazole, Econazole, Clotrimazole, BifonazoleTriazoles: Itraconazole, Fluconazol, Vorionazole → systemic treatment
11Mechanism of ActionReduction of ergosterol synthesis by inhibition of fungal cytochrome P450 enzymes.Greater affinity for funfal than for human cytochrome P450 enzymes.Imidazoles exhibit a lesser degree of specificity than the triazoles, accounting for their higher incidence of drug interactions and side effects.
12Ketoconazole The first oral azole introduced into clinical use. Less selective for fungal P450Inhibition of human P450 interferes with biosynthesis of adrenal and gonadal steroid hormones;Alter the metabolism of other drugs.Best absorbed at a low gastric pH.
13Miconazole, Econazole, Clotrimazole Bioavailability is low by taking orally.Used topically.
14BifonazoleDouble inhibition, antifungal action is more powerful.
15ItraconazoleIts absorption is increased by food and by low gastric pH.Treatment of dermatophytoses (皮真菌病) and onychomycosis (甲真菌病).The only agent with significant activity against aspergillus (曲霉菌) species.
16Fluconazol Water solubility and good cerebrospinal fluid penetration. The widest therapeutic index (治疗指数) of the azoles.Treatment and secondary prophylaxis (预防) of cryptococcal meningitis （隐球菌脑膜炎 ）.
17Vorionazole Available in an intreavenous and an oral formulation. Metabolism is predominantly hepatic, but the propensity for inhibition of mammalian P450 appears to be low.Similar to itraconazole in tits spectrum of action, having good activity against candida species.More effective than itraconazole.
18Acrylamide Include Naftifine and Terbinafine. non-competitive and reversible inhibitor of Squalene epoxidase.Terbinafine is synthetic, oral formulation.Fungicidal （杀菌剂）Treatment of dermatophytoses, especially onychomycosis, more effective than griseofulvin or itraconazole.
19Pyramine Flucytosine （5-FC）is a water-soluble pyrimidine analog. Its spectrum of action is much narrower than that of amphotericin B.Poorly protein-bound and penetrates well into all body fluid aompartments, including the cerebrospinal fluid.
20Synergy (协同) with amphotericin B. Mechanism5-FC (taken up by fungal cells via the enzyme cytosine permease) → 5-FU → F-dUMP and FUTP → inhibit DNA and RNA synthesis, respectively.Synergy (协同) with amphotericin B.Spectrum of action: Cryptococcus neoformans, some candida species, and the dematiaceous molds that cause chromoblastomycosis.
21Adverse effects: result from metabolism to fluorouracil (5-FU) Not used as a single agent because of its demonstrated synergy with other agents and to avoid the development of secondary resistance.Adverse effects: result from metabolism to fluorouracil (5-FU)Bone marrow toxicity with anemia, leukopenia, and thrombocytopenia