Antifungal agents抗黴菌藥

由於真菌和人類一樣是真核生物，所以比起原核生物的細菌較難找出有選擇性的藥品。

分類[]

影響細胞膜通透性[]

undecylenic acid十一烯酸[]

undecylenic acid(十一烯酸): infection of dermatophytes, fungistatic

多烯類抗生素[]

hexaene:nystatin:太毒以至於不全身性使用,但是由於口服吸收差所以可以治療口腔或是胃腸道黴菌
heptaene
- Amphotericin B: fungicidal. treats candida 不通過BBB, 所以如果要治療中樞神經感染則必須intrathecal inj. 有liposome的劑型
- Candicidin
- hamycin
- trichomycin
tetraene:natamycin: 5% suspension applied topically for eye infection

ergosterol biosynthesis inhibitors[]

azole類抗黴菌藥[]

imidazole antifungal agents
- ketoconazole: candidiasis
- econazole
- miconazole
- clotrimazole→flutrimazole
- tioconazole
- butoconazole
- sulconazole
- fenticonazole
- isoconazole
- sertaconazole
- croconazole→neticonazole
- oxiconazole
- lanzoconazole
- omoconazole
- chlormidazole
triazole antifungal agents
- itraconazole
- terconazole: treat vaginal candidiasis, local use only
- fluconazole: pass BBB and against Cryptococcus neoformans
- voriconazole: pass BBB and against Aspergillus, fluconazole-resistant Candida and Cryptococcus orally
- posaconazole: against Aspergillus and other increasingly common nosocomial infections resistant to other antifungal drugs

squalene epoxidase inhibitors[]

allyl amines
- naftifine: treat tinea infection of the skin topically
- terbinafine: treat dermatophytoses, especially onychomycoses orally or topically
others: 廣義的allyl amines
- butenafine:benzyl is bio-isosteric with allyl, treat tinea infection of the skin topically and superficial Candida albicans infection
- tolnaftate:thiocarbamate, treat tinea infection of the skin topically

morpholines[]

amorolfine: topical treatment of dermatophytic infection

抑制細胞壁的生合成[]

echinocandins :treat resistant Candida species, azole-resistant Aspergillus but Cryptococcus neoformans
- Caspofungin
- anidulafungin
- micafungin

擾亂核酸的代謝[]

flucytosine:因fluconazole而被取代, treat Candida and Cryptococcus neoformans
Griseofulvin(灰黴素): fungistatic, superficial fungal infection. oral or topical. 脂溶性，所以要做成水溶液必須做成O/W乳劑。也因為溶解度不好所以吸收時不好吸收，但是如果和油脂性食物一起食用則因為油脂刺激膽汁(界面活性劑的功能)的分泌所以可以使Griseofalvin濕潤而增加吸收 (但是減小吸收速率)。減小其顆粒大小也可以增加吸收。灰黴素Griseofulvin和phenytoin在玉米油懸浮液中口服也可以刺激膽汁分泌而增加吸收。

機轉不明[]

haloprogin:topical use only

多價離子螯合劑[]

ciclopirox: superficial dermatophytic infection, principally onychomycosis

其他[]

Benzoic acid(苯甲酸)(安息香酸):和salicylic acid製成Whitfield's ointment治療香港腳 Tyler
Methylparaban:對黴菌有很好的效果(8807國考考過了)
Chlorobutanol(氯丁醇):對抗細菌和黴菌
phenylmercuric salt(苯汞鹽)為有機汞化合物，包含兩種:phenylmercuric acetate(醋酸苯汞)和phenylmercuric nitrate(硝酸苯汞):對抗細菌和黴菌
thimersal(硫柳汞):為有機汞化合物，對抗細菌和黴菌
silver sulfadiazine治療燒傷也可以抗黴菌:Candida albicans(白色念珠菌

重點[]

疾病[]

甲黴菌病(onychomycosis)，又稱甲癬(tinea unguium)，俗稱灰指甲

systematic use[]

- imidazole antifungal agents
  - ketoconazole
- triazole antifungal agents
  - itraconazole
  - fluconazole: pass BBB and against Cryptococcus neoformans
  - voriconazole: pass BBB and against Aspergillus, fluconazole-resistant Candida and Cryptococcus
  - posaconazole: against Aspergillus and other increasingly common nosocomial infections resistant to other antifungal drugs

local use[]

- imidazole antifungal agents
  - ketoconazole
  - econazole
  - miconazole
  - clotrimazole→
  - tioconazole
  - butoconazole
  - sulconazole
  - oxiconazole
- triazole antifungal agents
  - terconazole: treat vaginal candidiasis, local use only

治療學[]

一般的藥可以治療 Candida species,強一些的藥可以治療Cryptococcus neoformans

,Aspergillus,像是azole類抗黴菌藥.但是echinocandins :treat resistant Candida species, azole-resistant Aspergillus but Cryptococcus neoformans

延伸學習[]

Chemotherapy(化學療法

國考不會考(中文維基百科20151215)[]

黃葉病（又名萎蔫病、巴拿馬病）是出現在香蕉根部的植物病。黃葉病由Fusarium oxysporum f.sp. cubense尖孢鐮刀菌古巴專化型引起。尖孢鐮刀菌透過分泌毒素，引發香蕉出現細胞程序性死亡。此真菌對殺真菌劑有抵抗力，至今無藥可治。黃葉病又被稱為「香蕉癌症」，在2009年曾因此名稱在中國傳出香蕉致癌的傳言，各地的香蕉價格慘跌。

2019超級細菌耳念珠真菌[]

主條目:模板:抗藥性歷史

一些科學家認為，殺真菌劑在農業領域被濫用也是造成影響人類生命安全的抗藥真菌「蓬勃發展」的其中一個主因。此次的爆發通常對一至三種抗黴菌藥有抗藥性。(2019 年 04 月 08 日 13:30耳念珠菌全球蔓延，美國 587 病例近半 90 天內不治 )

2019-04-08致死數恐超越癌症　超級細菌耳念珠菌擴散:應該是超級細菌耳念珠真菌