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Antifungals Commonly Used in Dentistry: Assessment, Analysis, and Associated Dental Management Guidelines

POLYENE AND AZOLE ANTIFUNGALS: OVERVIEW, FACTS, AND PRESCRIPTIONS

Two distinct classes of antifungal medications used in dentistry are the polyenes and the azole antifungals.

Polyene Antifungals: Mechanism of Action

Polyenes bind with ergosterol in the fungal cells and form holes, causing cell death due to the leaking out of the cell contents.

Polyene Drug Classifications

Polyene drugs include:

Azole Drugs Classification

Azole drugs are classified as:

Imidazole and Triazole Antifungals: Mechanism of Action and Facts

Imidazole and triazole antifungals inhibit the CYP450 enzyme, thus preventing the formation of ergosterol and fungal cell membrane synthesis.

Fluconazole and itraconazole, the newer azole antifungals, generally have fewer side effects. They are used a lot more for treatment of fungal infections in the immune-compromised patient compared to ketoconazole. They both affect the fungal cell membrane a lot more than ketoconazole. Hence lower doses are needed for optimal effectiveness.

Topical and Oral Nystatin

Nystatin Facts

The topical and oral forms of nystatin are not absorbed on ingestion and consequently are not associated with any DDIs. The oral form is used to treat oral or esophageal fungal infections. Both forms of nystatin are commonly used in HIV/AIDS patients with a low CD4 count, in patients undergoing chemotherapy, and in patients in whom azole antifungals are contraindicated. Nystatin is in Pregnancy Category B. Nystatin suspension is the drug of choice for patients experiencing xerostomia.

Nystatin (Mycostatin) Prescriptions