Antifungal tablet

Itraconazole

This is used for oral thrush, fungal infection in the lungs, fungal nail infections and pityriasis versicolor.  It interacts with a lot of prescribed medications so should be used with caution.  It should not be taken during pregnancy unless life-threatening intervention is needed and should be avoided in breastfeeding as it can accumulate in the milk.

Fluconazole

This is mainly used for treating vaginal thrush, where it is taken as a one-time dose of 150 mg.  If you have recurrent thrush, then a 6-month course might be recommended at 150 mg every 72 hours for 3 doses, then once a week for 6 weeks.  It should not be taken in pregnancy but can be taken when breastfeeding. It is also used in oral thrush where a 50 mg dose is given for 7-14 days.

The imidazole antifungals include clotrimazole, ketoconazole, econazole, and tioconazole. These are used for the local treatment of vaginal thrush and for skin infections. Another type called miconazole can also be used for mouth infections and can be effective in treating fungal gut infections.

Polyene antifungals

These antifungals include amphotericin B and nystatin. Neither of these can be given as a tablet because they’re not absorbed when given by mouth. Nystatin is used for mouth infections by local application as well as for treating Candida skin infections. Amphotericin B is an intravenous treatment (given through a drip into a vein) for the treatment of systemic fungal infections and is active against most fungi and yeasts.

Echinocandin antifungals include anidulafungin, caspofungin and micafungin. They are not commonly used and are only effective against Aspergillus and Candida infections.

Terbinafine tablets are used to treat athlete’s foot, ringworm, jock itch, fungal nails and pityriasis versicolor but are only given if the creams haven’t worked. In fungal nail infections, this is taken as 250 mg once a day for 6 weeks to 3 months or longer. It’s important to check liver function before starting the tablets and one month after as it can cause liver dysfunction. It is best to avoid both in pregnancy and breastfeeding.