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You are here: Drugs > Medical >
  Content Director:  
Russell E. Lewis, Pharm.D. 
Russell E. Lewis, Pharm.D.  
Other Topical Agents

There are a number of topical agents used in treatment of superficial cutaneous mycoses, oropharyngeal candidiasis, and vulvovaginal candidiasis. The superficial cutaneous mycoses that respond to topical therapy include the localized infections of hair, nails, and epidermis due to the dermatophytes and Candida. While some of these topical agents are polyenes, azoles (imidazoles) or allylamines, others are of distinct chemical classes.

In addition to those used for treatment of cutaneous, oropharyngeal, and vulvovaginal fungal infections, an ophthalmic topical antifungal agent, pimaricin (natamycin) is also available. Pimaricin is a polyene used in treatment of keratomycosis. Its commercial formulation is an ophthalmic suspension available in USA (Natacyn™, Alcon Laboratories, Inc., Forthworth, TX). Following ophthalmic installation, pimaricin adheres to the corneal ulcer base very effectively and exerts favorable therapeutic efficacy. Pimaricin suspension is usually applied in concentrations of 2.5 to 5%. It may be used alone or in combination with topical or systemic azole preparations or amphotericin B, depending on the severity of the infection [462, 1139, 1866, 1963, 2223].

Pimaricin is effective mostly against moulds. While it is usually effective in vitro and in vivo against particularly Fusarium spp., clinical failure or in vitro resistance of this fungus against pimaricin has also been reported [861, 1899, 1973]. Similarly, its in vitro or in vivo activity in keratomycosis due to Pseudallescheria boydii may also vary [777, 1541, 1973].

Topical azoles are usually preferred in treatment of keratomycosis due to yeasts. Nevertheless, there are reports on favorable activity of pimaricin in cases due to yeasts as well. Concommittant therapy with pimaricin ointment and local amphotericin B injection to anterior chamber has been effective in keratomycosis due to Candida tropicalis [210].

Pimaricin is effective also against Exserohilum rostratum, Acremonium spp., and Cunninghamella spp.[73, 1973]. On the other hand, Aspergillus spp. , and dermatophytes are frequently resistant to pimaricin [1399, 1866].

The major characteristics of the currently available topical antifungal agents that are in general effective in treatment of superficial cutaneous mycoses and/or candidiasis are shown below [85, 899, 1274, 1744, 1886, 2057, 2092].

Agents which have limited applications and/or unclear efficacy are not included in the list. For more detailed information about clinical use of these agents, refer to the page on related infection. For detailed information on systemic use of polyenes, azoles, and allylamines, refer to the related pages.

Chemical Class

  Generic Name
Trade names Manufacturers Formulations Indications
  Amphotericin B     C, L, O CC
  Fungizone Bristol MyersSquibb    
  Nystatin     C, O, OS, P, VT, T CC, OC, VC
  Mycostatin Bristol MyersSquibb    
  Nilstat Wyeth-Ayerst    
  Mykinac Alpharma    
  Pedi-Dri Pedinol Pharmacal    
Azoles (Imidazoles)        
  Butoconazole     C VC
  Femstat Bayer    
  Clotrimazole     C, L, S, T, VT D, CC, OC, VC
  Fungoid Pedinol Pharmacal    
  Lotrimin Schering    
  Mycelex Bayer    
  Gyne-Lotrimin Schering    
  Econazole     C D, CC
  Spectazole Ortho Dermatological    
  Ketoconazole     C, S D, CC
  Nizoral Janssen Pharmaceu.    
  Miconazole     C, L, S, P, VS D, CC, VC
  Micatin McNeil    
  Monistat-Derm Ortho Dermatological    
  Monistat-7 Ortho Dermatological    
  Monistat-3 Ortho Dermatological    
  Oxiconazole     C, L D, CC
  Oxistat Glaxo Wellcome    
  Sulconazole     C, S D, CC
  Exelderm Westwood-Squibb    
  Terconazole     C, VS VC
  Terazole 3 Ortho McNeil    
  Terazole 7 Ortho McNeil    
  Tioconazole     C, VO VC
  Vagistat-1 Bristol-Myers Squibb    
Allylamines and other non-azole ergosterol synthesis inhibitors        
  Amorolfine     NL O
  Loceryl Roche Laboratories    
  Butenafine HCl     C D
  Mentax Penederm    
  Naftifine     C, O, P D
  Naftin Allergan    
  Terbinafine     C, S D
  Lamisil Sandoz Pharmaceu.    
Other agents        
  Ciclopirox olamine Loprox Hoechst Marion Roussel C, L D, CC
  Penlac Dermic NL O
  Haloprogin     C D, CC
  Halotex Westwood Squibb    
  Tolnaftate     C, S, P D
  Aftate Schering-Plough    
  NP-27 Thompson Medical    
  Tinactin Schering-Plough    
  Ting Fisons    
  Undecylenate     C, P, O, S D
  Cruex Fisons    
  Desenex Fisons    

C: cream L: lotion

NL: nail lacquer O: ointment

OS: oral suspension P: powder

S: solution/spray VO: vaginal ointment

VS: vaginal suppository T: troche VT: vaginal tablet

D: dermatophytosis CC: cutaneous candidiasis

OC: oropharyngeal candidiasis VC: vulvovaginal candidiasis


73. Anandi, V., J. A. George, R. Thomas, K. N. Brahmadathan, and T. J. John. 1991. Phaeohyphomycosis of the eye caused by Exserohilum rostratum in India. Mycoses. 34:489-91.

85. Anonymous. 2000. Cicloprox (Penlac) nail lacquer for onychomycosis. The Medical Letter. 42:51.

210. Behrens-Baumann, W., R. Ruechel, O. Zimmermann, and M. Vogel. 1991. Candida tropicalis endophthalmitis following penetrating keratoplasty. Br. J. Opthalmol. 75:565.

462. Collier, L., A. Balows, and M. Sussman. 1998. Topley & Wilson's Microbiology and Microbial Infections, 9th ed, vol. 4. Arnold, London, Sydney, Auckland, New York.

777. Friedman, D. S., J. V. Schoster, J. P. Pickett, R. R. Dubielzig, C. Czuprynski, J. S. Knoll, and L. J. Wolfgram. 1989. Pseudallescheria boydii keratomycosis in a horse. J Am Vet Med Assoc. 195:616-8.

861. Goldblum, D., B. E. Frueh, S. Zimmerli, and M. Bohnke. 2000. Treatment of postkeratitis fusarium endophthalmitis with amphotericin B lipid complex [In Process Citation]. Cornea. 19:853-6.

899. Greenspan, D. 1994. Treatment of oropharyngeal candidiasis in HIV-positive patients. J. Amer. Acad. Dermatol. 31 (Suppl. 2):S51-S55.

1139. Jones, D. B. 1978. Therapy of postsurgical fungal endophthalmitis. Ophthalmology. 85:357-73.

1274. Kwon-Chung, K. J., and J. E. Bennett. 1992. Medical Mycology. Lea & Febiger, Philadelphia.

1399. Macura, A. B. 1993. In vitro susceptibility of dermatophytes to antifungal drugs: a comparison of two methods. Int. J. Dermatol. 32:533-6.

1541. Mills, R., and G. Garrett. 1992. Pseudallescheria boydii keratitis. Aust N Z J Ophthalmol. 20:253-6.

1744. Pelletier, R., J. Peter, C. Antin, C. Gonzalez, L. Wood, and T. J. Walsh. 2000. Emergence of resistance of Candida albicans to clotrimazole in human immunodeficiency virus-infected children: In vitro and clinical correlations. J Clin Microbiol. 38:1563-8.

1866. Rahman, M. R., G. J. Johnson, R. Husain, S. A. Howlader, and D. C. Minassian. 1998. Randomised trial of 0.2% chlorhexidine gluconate and 2.5% natamycin for fungal keratitis in Bangladesh. Br J Ophthalmol. 82:919-25.

1886. Reef, S. E., W. C. Levine, M. M. McNeil, S. Fisher-Hoch, S. D. Holmberg, A. Duerr, D. Smith, J. D. Sobel, and R. W. Pinner. 1995. Treatment options for vulvovaginal candidiasis. Background paper for development of 1993 STD treatment recommendations. Clin. Infect. Dis. 20 (Suppl. 1):S80-S90.

1899. Reuben, A., E. Anaissie, P. E. Nelson, R. Hashem, C. Legrand, D. H. Ho, and G. P. Bodey. 1989. Antifungal susceptibility of 44 clinical isolates of Fusarium species determined by using a broth microdilution method. Antimicrob. Agents Chemother. 33:1647-1649.

1963. Rosa, R. H., Jr., D. Miller, and E. C. Alfonso. 1994. The changing spectrum of fungal keratitis in south Florida. Ophthalmology. 101:1005-13.

1973. Rotowa, N. A., H. J. Shadomy, and S. Shadomy. 1990. In vitro activities of polyene and imidazole antifungal agents against unusual opportunistic fungal pathogens. Mycoses. 33:203-11.

2057. Schopf, R., O. Hettler, M. Brautigam, G. Weidinger, U. Kaben, P. Mayser, and V. Resl. 1999. Efficacy and tolerability of terbinafine 1% topical solution used for 1 week compared with 4 weeks clotrimazole 1% topical solution in the treatment of interdigital tinea pedis: a randomized, double-blind, multi-centre, 8-week clinical trial. Mycoses. 42:415-420.

2092. Sheehan, D. J., C. A. Hitchcock, and C. M. Sibley. 1999. Current and emerging azole antifungal agents. Clin. Microbiol. Rev. 12:40-79.

2223. Tanure, M. A., E. J. Cohen, S. Sudesh, C. J. Rapuano, and P. R. Laibson. 2000. Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania. Cornea. 19:307-12.

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