There are several different antifungal preparations that are used to treat various fungal infections. They come as creams, sprays, solutions, shampoos, tablets designed to go into the vagina (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 as long as eight weeks (for example, for ringworm infection of the scalp).
What are fungal infections?
Fungal infections on, or near to the surface of the body
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, athlete's foot (tinea pedis) is a common fungal infection of the toes and feet. Tinea infection also causes ringworm (tinea corporis) and ringworm of the scalp (tinea capitis). It also causes many fungal nail infections. A common fungal infection of the mouth and of the 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 harmlessly on the skin. However, certain conditions can cause candida to multiply and cause infection. Candida is also sometimes the cause of some fungal nail infections.
Fungal infections within the body
Fungal infections of the skin, nails, vagina and mouth are quite common. They 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, sprays, solutions, tablets designed to go into the vagina (pessaries), 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, liquids or sprays (topical antifungals)
These are used to treat fungal infections of the skin, scalp and nails. They include clotrimazole, econazole, ketoconazole, miconazole, tioconazole, terbinafine, and amorolfine. 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 help treat scalp fungal infections and certain skin conditions.
Pessaries are tablets which are designed to be put into the vagina. Some antifungal medicines are used as pessaries to treat vaginal thrush, particularly clotrimazole, econazole, miconazole, and fenticonazole
Antifungal medicines taken by mouth
There are various types. For example:
Terbinafine, itraconazole, fluconazole, posaconazole, and voriconazole are available 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, which are antibacterial medicines. Antibiotics do not kill fungi - they kill other types of germs (called bacteria). 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, sprays, liquids and shampoos. These usually cause no side-effects and are easy to use. Occasionally some people get a little bit of itch, burning or redness where the antifungal preparation has been applied. If this is severe, you should stop using it. 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 more serious side-effects in a small number of people. A few common possible side-effects of some of the more widely used antifungal medicines are as follows:
- Terbinafine sometimes causes tummy aches, loss of appetite, feeling sick (nausea), tummy upsets, diarrhoea, headache, rash, taste disturbance and muscle or joint pains.
- Fluconazole may cause nausea, tummy ache, diarrhoea, wind, headache, or a rash.
- Miconazole may cause nausea or sickness (vomiting), or a rash.
- Nystatin may cause soreness of the mouth.
- 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 (eg, for vaginal thrush); other courses can be a long as eight weeks (eg, for ringworm infection of the scalp).
Who cannot take or use antifungal medicines?
Most people are able to use topical antifungals and take oral antifungals. The doctor or pharmacist who advises you will check to see if they are suitable for you specifically. However, even if you are unable to take one antifungal, your doctor can usually find one to suit you.
If you are pregnant, or have severe liver disease or kidney disease you may not be able to take the oral antifungal tablets. Children are not usually prescribed oral antifungal medicines, and if they are prescribed, it is usually by a specialist.
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 or any other healthcare products 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.
- 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 - body and groin; NICE CKS, September 2014 (UK access only)
- Fungal skin infection - foot; NICE CKS, September 2014 (UK access only)
- Fungal nail infection; NICE CKS, September 2014 (UK access only)
- Candida - oral; NICE CKS, July 2013 (UK access only)
- Fungal skin infection - scalp; NICE CKS, September 2014 (UK access only)
- Candida - female genital; NICE CKS, December 2013 (UK access only)
- British National Formulary; NICE Evidence Services (UK access only)
- Fungal skin infections; DermNet NZ
- Rotta I, Ziegelmann PK, Otuki MF, et al; Efficacy of topical antifungals in the treatment of dermatophytosis: a mixed-treatment comparison meta-analysis involving 14 treatments. JAMA Dermatol. 2013 Mar;149(3):341-9. doi: 10.1001/jamadermatol.2013.1721.
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 makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Mary Harding
Dr John Cox