There are several different antifungal preparations that are used to treat various fungal infections.They come as creams, shampoos, pessaries, medicines to take by mouth, and injections. The length of treatment depends on what type of fungal infection you have, how severe it is and if you have any other health problems - for example, problems with your immune system. Some courses of treatment can be as short as a few days (for example, for vaginal thrush), other courses can be a long as ten weeks (for example, for ringworm infection of the scalp).
What are fungal infections?
Fungal infections of the skin, nail, mouth and vagina
Many types of fungal germs (fungi) live harmlessly in the soil, on food, on our skin and in other places in the environment. However, some types of fungi can thrive and multiply on the surface of the body, to cause infection of the skin, nails, mouth or vagina.
The most common fungi to cause skin infections are the tinea group of fungi. For example, tinea pedis (athlete's foot) is a common fungal infection of the toes and feet. A common fungal infection of the mouth and vagina is called thrush. This is caused by an overgrowth of candida which is a yeast (a type of fungus). Small numbers of candida commonly live on the skin. However, certain conditions can cause candida to multiply and cause infection.
There are a number of leaflets giving details of the common fungal infections - for example, see leaflets called 'Fungal Nail Infection' and 'Ringworm of the Scalp' and 'Athlete's Foot'.
Fungal infections within the body
Fungal infections of the skin, nails, vagina and mouth are quite common, but are rarely serious and don't usually spread deeper into the body. If you are otherwise healthy and have a normal immune system, it is rare for fungi to affect internal organs. However, fungal infections of the heart, lung, brain and other organs sometimes do occur. These internal fungal infections can be serious and, sometimes, life-threatening.
Various types of fungus can cause internal infections. For example:
- Aspergillosis most commonly affects the lungs, but sometimes infects other organs.
- Cryptococcosis is uncommon, but can cause meningitis.
- Histoplasmosis is rare, but can cause serious infections of the lung and other organs.
You are more at risk of developing an internal fungal infection if your immune system does not work properly. For example, if you are taking chemotherapy, if you have HIV/AIDS, etc. Some people with a poor immune system are prescribed regular antifungal medication to prevent serious fungal infections from developing.
What are antifungal medicines and how do they work?
There are several types of antifungal medicines. They come as creams, pessaries (a tablet designed to go into the vagina), shampoos, medicines to take by mouth, and injections. Most work by damaging the cell wall of the fungus, which causes the fungal cell to die. People who are prescribed an antifungal injection are usually in hospital and are very ill.
Antifungal creams pessaries, or sprays (topical antifungals)
These are used to treat fungal infections of the skin and vagina. They include: clotrimazole, econazole, ketoconazole, miconazole, tioconazole, terbinafine, nystatin, amorolfine and griseofulvin. They come in various different brand names.
Sometimes an antifungal cream is combined with other creams when two actions are required. For example, an antifungal cream is often combined with a mild steroid cream, such as hydrocortisone, to treat certain rashes. The antifungal cream clears the infection, and the mild steroid cream reduces the inflammation caused by the infection.
A shampoo which contains ketoconazole is sometimes used to treat scalp fungal infections.
Antifungal medicines taken by mouth
There are various types. For example:
Miconazole comes as an oral gel, and nystatin come as a liquid. Neither of these medicines is absorbed through the gut into the body. They are used to treat candidal infections (thrush) of the mouth and throat.
- Terbinafine, itraconazole, fluconazole, griseofulvin, posaconazole, and voriconazole come as tablets, which are absorbed into the body. They are used to treat various fungal infections. The one chosen depends on what type of infection you have. For example:
- Terbinafine is commonly used to treat nail infections which are usually caused by a tinea type of fungus.
- Fluconazole is commonly used to treat vaginal thrush, as an alternative to using antifungal cream. It is also used to treat and prevent certain fungal infections within the body.
These may be used if you have a serious fungal infection within the body. Amphotericin, flucytosine, itraconazole, voriconazole, anidulafungin, caspofungin, and micafungin are medicines that are sometimes used in this way. The one chosen depends on the type of fungus causing the infection.
Note: antifungal medicines are different to antibiotics (antibacterial medicines). Antibiotics do not kill fungi - they kill bacteria (a different type of germ). In fact, you are more prone to getting a fungal infection if you take antibiotics. For example, many women develop thrush after taking a course of antibiotics. This is because the antibiotic may kill the normal harmless bacteria that live on your skin or vagina and make it easier for fungi to flourish.
What are the possible side-effects?
You should read the information leaflet that comes with your particular brand for a full list of cautions and possible side-effects. As a general rule:
- Antifungal creams and shampoos. These usually cause no side-effects and are easy to use. Occasionally, some women develop irritation around the vagina after applying vaginal antifungal products.
- Antifungal medicines by mouth. The most widely used are terbinafine for nail infections, miconazole, and nystatin for oral thrush, and fluconazole for vaginal thrush. These usually cause no side-effects. You can even buy fluconazole without a prescription at pharmacies, as it is considered a medicine which is unlikely to cause problems. Some antifungal preparations cause liver problems or other side-effects in a small number of people.
- Antifungal injections. These have more risk of causing side-effects and sometimes serious problems. However, these are used to treat serious fungal infections and the risk of side-effects needs to be balanced against the need for treatment.
What is the usual length of treatment?
The length of treatment depends on what type of fungal infection you have, how severe it is and if you have any other health problems - for example, problems with your immune system. Some courses of treatment can be as short as a few days (for example, for vaginal thrush); other courses can be a long as ten weeks (for example, fo ringworm infection of the scalp).
Who cannot take or use antifungal medicines?
Most people are able to use topical antifungals and take oral antifungals. However, even if you are unable to take one antifungal, your doctor can usually can find one to suit you.
Some oral antifungals may interact with other medicines that you might take. This may cause reactions, or reduce the effectiveness of one or other of the treatments. So, when you are prescribed an antifungal, you should tell a doctor if you take other medicines.
Can I buy antifungal medicines?
Yes - there a number of antifungal creams you can buy at your pharmacy (for example, clotrimazole, and terbinafine). In addition, you can also buy oral fluconazole from your pharmacy, to treat vaginal thrush.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- Information about the person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.
Further reading & references
- Fungal skin infection - foot; NICE CKS, May 2009
- Fungal skin infection - body and groin; NICE CKS, May 2009
- Fungal nail infection (onychomycosis); NICE CKS, May 2009
- Candida - oral; CKS NICE, September 2009
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Mrs Jenny Whitehall
Prof Cathy Jackson