yeast vs mould
- Yeasts: Candida spp, Cryptococcus.
- Moulds: Aspergillus, Mucor, Fusarium.
- Dimorphic: Histoplasma, Blastomyces, Coccidioides.
1. azoles (inhibit ergosterol synthesis)
| Drug | Spectrum | Key Role | Notes |
|---|---|---|---|
| Fluconazole | Yeasts Only (Excl. C. krusei, C. glabrata often resistant) | Candidemia (albicans), Thrush, Meningitis (Crypto). | Excellent PO bioavailability. NO Mould coverage. |
| Voriconazole | Yeasts + Moulds (Aspergillus) | Invasive Aspergillosis (Gold Standard). | Visual hallucinations, Fluorosis, Skin Ca. |
| Posaconazole | Yeasts + Moulds + Mucor | Prophylaxis in AML/GVHD. | Needs fatty meal (liquid) or tablet absorption. |
2. echinocandins (cell wall inhibitors)
- Agents: Caspofungin, Micafungin, Anidulafungin.
- Spectrum: Yeasts (Fungicidal) + Aspergillus (Static).
- Role: First-line for Invasive Candidiasis (covers fluconazole-resistant strains).
- Safety: Very well tolerated. No renal/hepatic adjustment usually needed. IV only.
3. polyenes (pore formers)
- Agent: Liposomal Amphotericin B (AmBisome).
- Spectrum: Broadest (Yeasts, Moulds, Mucor, Protozoa).
- Role: Severe/Refractory infections, Mucormycosis, Cryptococcal Meningitis (Induction).
- Toxicity: “Amphoterrible” (Renal tubular acidosis, wasting, rigors). Liposomal formulation reduces nephrotoxicity.