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Fungal infections are caused by fungi. Tinea and candidiasis are the most common fungal infections, which affect superficial or mucocutaneous body parts including the hair, skin, nail, mouth, oesophagus and vagina. For superficial fungal infections, symptoms are generally mild. For invasive fungal infections (e.g. aspergillosis), patients may experience more severe symptoms such as fever, chest pain, shortness of breath and weight loss.

Azoles
Azoles are the most commonly used broad-spectrum antifungals. Voriconazole is a second-generation triazole active against a variety of invasive fungi including Aspergillus and Candida resistant to Fluconazole. It is the first-line antifungal for the treatment of aspergillosis. Azoles are strong CYP3A4 inhibitors and concurrent use with CYP3A4 substrates should be avoided.

Echinocandins
Echinocandins are active against Candida, but other classes of fungi (e.g. Cryptococcus, Trichosporon) are resistant to echinocandins. They are mainly used for the treatment of azole-resistant candidiasis. Some echinocandins requires dosage adjustment in patients with hepatic impairment.

Polyenes
Amphotericin B is a potent broad-spectrum antifungal. It is reserved for life-threatening fungal infections due to severe side effects, including infusion reactions, nephrotoxicity and hepatotoxicity.