Imidazoles and triazoles

Miconazole, ketoconazole, fluconazole, and itraconazole are active against most fungi except Aspergillus species. They act by inhibiting the production of the fungal cell membrane. Miconazole is not reliable in systemic infections, and ketoconazole is not effective against deep candidiasis. Fluconazole is well absorbed orally and can be given intravenously. Its long half-life allows once-daily dosing. It penetrates most tissues and is excreted renally, largely unchanged. Dosage must be reduced in renal failure. Adverse effects are rare. It is highly effective in mucosal candidiasis, but efficacy in other systemic infections is less well established.

Itraconazole is given orally and is distributed throughout the body except the cerebrospinal fluid. It is used to treat histoplasmosis, paracoccidiodomycosis, and blastomycosis, and can be given to patients with invasive aspergillosis in the presence of immune suppression.

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