Essential antifungal agents as assessed by the WHO. Access and antifungal price by country is visible here: https://wwwgaffiorg/antifungal-drug-maps/.
Antifungal | Route(s) | Primary indications | Resistance concerns |
Griseofulvin | Oral | Tinea corporis and capitis | Some clinical resistance described |
Fluconazole | Oral, IV | Mucosal candidiasis, prophylaxis in leukaemia, HSCT and intensive care, treatment and maintenance therapy for cryptococosis | All moulds, including Aspergillus resistant. Lower response rates for endemic mycoses such as histoplasmosis. All Candida auris and Candida krusei strains resistant—some other species less susceptible or resistant |
Amphotericin B | IV and topical | Invasive candidiasis and cryptococcal meningitis, endemic fungal infections. Empiric therapy in febrile neutropenia. Lower response rate for invasive aspergillosis than azoles | Aspergillus terreus and nidulans resistant. Some strains of Candida auris resistant. Several intrinsically resistant fungi |
Flucytosine | Oral, IV* | Cryptococcal meningitis, neonatal candidiasis and Candida endocarditis and endophthalmitis, other rare fungal infections | Low levels of resistance in Candida and Cryptococcus. Aspergilli and most moulds and endemic fungi resistant |
Itraconazole | Oral, IV* | All skin infections, all forms of aspergillosis, endemic fungal infections, mucosal candidiasis, prophylaxis in leukaemia | Rising problems with resistance in Aspergillus fumigatus, flavus and niger. Some cross resistance with fluconazole in Candida |
Voriconazole | Oral, IV | Invasive and chronic aspergillosis, some rare moulds | Some azole cross resistance in Aspergillus. Mucorales intrinsically resistant |
Natamycin 5% | Topical, eye | Fungal keratitis | Most effective agent, but some rarer fungi resistant, probably |
Echinocandins (micafungin, caspofungin, anidulafungin) | IV | Candidaemia, invasive candiasis, invasive and chronic pulmonary aspergillosis, prophylaxis | Most effective agent for most Candida infections, notably the majority of Candida auris strains. Less effective than azoles for aspergillosis. |
*Many countries only have oral
HSCT, haematopoetic stem cell transplant; ; IV, intravenous.