Table 1

Essential antifungal agents as assessed by the WHO. Access and antifungal price by country is visible here: https://wwwgaffiorg/antifungal-drug-maps/.

AntifungalRoute(s)Primary indicationsResistance concerns
GriseofulvinOralTinea corporis and capitisSome clinical resistance described
FluconazoleOral, IVMucosal candidiasis, prophylaxis in leukaemia, HSCT and intensive care, treatment and maintenance therapy for cryptococosisAll 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 BIV and topicalInvasive 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
FlucytosineOral, IV*Cryptococcal meningitis, neonatal candidiasis and Candida endocarditis and endophthalmitis, other rare fungal infectionsLow levels of resistance in Candida and Cryptococcus. Aspergilli and most moulds and endemic fungi resistant
ItraconazoleOral, IV*All skin infections, all forms of aspergillosis, endemic fungal infections, mucosal candidiasis, prophylaxis in leukaemiaRising problems with resistance in Aspergillus fumigatus, flavus and niger. Some cross resistance with fluconazole in Candida
VoriconazoleOral, IVInvasive and chronic aspergillosis, some rare mouldsSome azole cross resistance in Aspergillus. Mucorales intrinsically resistant
Natamycin 5%Topical, eyeFungal keratitisMost effective agent, but some rarer fungi resistant, probably
Echinocandins (micafungin, caspofungin, anidulafungin)IVCandidaemia, invasive candiasis, invasive and chronic pulmonary aspergillosis, prophylaxisMost 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.