Polyene antibiotics include amphotericin and nystatin. They are active against both yeast-like and filamentous fungi. Resistance in fungi normally sensitive to polyene antifungals is virtually unknown. Oral formulations of amphotericin and nystatin are useful for oral thrush and intestinal candidiasis and for suppression of candida in the GI tract, which may be acting as a reservoir in recurrent vaginal infection. Intravenous amphotericin is used for life-threatening systemic mycoses. Two types of formulation are available, conventional aqueous formulations (Fungizone) and lipid-based formulations (Abelcet, Ambisome and Amphocil). Lipid-based formulations can be given at higher doses than conventional formulations and are used in severe mycoses where toxicity precludes the use of Fungizone.
Note: Fatal errors have occurred because of confusion between the two types of formulation. Check carefully. Under no circumstances should the total dose of Fungizone exceed 1.5mg per kg daily.
The main indications of the imidazoles and triazoles are vaginal candidiasis (see genital infections section in the Genito-urinary System chapter), dermatophyte infections (see skin and nail infections section in the Skin chapter) and oral or intestinal candidiasis (see mouth and throat disorders section in the Ear, Nose and Throat chapter). Fluconazole can be used to treat candidal infections at all mucosal sites, systemic candidiasis and for the treatment and prophylaxis of cryptococcosis.