What are antifungal medicines?

Antifungal medicines ('antifungals') are medicines used to treat fungal infections. If you have an infection on the skin or nails, or in the mouth or vagina you may use the medicine directly on the area that has the infection. The medicine may be in the form of a cream, oral drop, lozenge, pessary, powder or nail lacquer. Many antifungals are available in tablet or capsule form, and if your infection is severe, your doctor may give you an antifungal injection.

Which conditions do antifungal medicines treat?

Antifungals treat infections caused by fungus. Common fungal infections include:

• Tinea — a common fungal infection found in moist, warm parts of the body, which cause athlete's foot, ringworm of the scalp and body, jock itch and nail infections.
• Thrush — a yeast infection caused by an overgrowth of a fungus called candida. Thrush can occur in the mouth, vagina or genitals in males.

Anyone can get a fungal infection but you are more likely to develop fungal infections if you have a weakened immune system.

Rarely, severe fungal infections can get inside your body and affect your bloodstream and body organs. These may occur if you have weakened immune system; for example, if you are taking medicines for an organ transplant or are receiving treatment for cancer.

How do antifungal medicines work?

There are many different antifungals, but they all work through 1 of 2 ways:

• 'Fungistatics' stop the fungus from growing normally so your body's immune system can break them down. Examples include azoles (for example clotrimazole, ketoconazole and fluconazole).
• 'Fungicidals' kill the fungus and stop the infection; for example, terbinafine.

Different preparations are recommended for different parts of the body, and some infections need treatment for a longer time than others.

• Creams, ointments, powders and gels are applied to the skin and treat skin infections.
• Internal creams and pessaries are inserted into the vagina to treat vaginal thrush.
• Oral drops, lozenges and oral gels are put in the mouth to treat oral thrush.
• Nail lacquers are applied to nails.

How long you need treatment for will vary depending on where the infection is and how severe it is. You will usually need 1 to 2 weeks of treatment with a cream to treat a skin infection. But some nail infections can take up to 12 months to treat.

• Antifungal treatments need to be used regularly to effectively treat the infection, and fungistatic creams for tinea infections should be continued for 2 weeks after the signs of infection have gone away to help prevent the infection coming back.

Check with your pharmacist or doctor about how long you will need to continue treatment for.

Do I need a prescription for antifungal medicines?

Creams for skin infections and nail lacquers are available from a pharmacy without a prescription.

Internal creams, pessaries and other treatments for vaginal thrush, and oral gels and drops for oral thrush are kept behind the counter in the pharmacy, and you will need to speak to the pharmacist to buy these.

You need a prescription from your doctor to buy most antifungal tablets.

If you have tried an antifungal treatment and your condition has not improved, or the infection returns, speak to your doctor.

Do antifungal medicines have any side effects?

Treatments used on the skin may cause some mild irritation of the area but antifungal creams don't usually cause serious side effects.

If you take azoles (such as fluconazole) in tablet/capsule form, they may also cause stomach upset, rash or abdominal pain.

It is important that you tell your doctor or pharmacist if you are taking any other medicines since there may be drug interactions with azoles. Your doctor will also not prescribe azoles if you have severe liver disease. Some azoles are not safe for people who have heart failure, and some may need a dose adjustment if you have kidney disease.

Terbinafine tablets may cause stomach upset, rash, headache or muscle aches. It can make conditions such as lupus and psoriasis worse. You shouldn't take terbinafine if you have severe liver disease.

You should speak to your doctor or pharmacist before taking antifungal medicines (including creams) if you are pregnant or breastfeeding.

If you develop side effects or if the infection does not clear up, speak to your doctor — you may need a different treatment, or your condition may have a different cause.

Are there any alternatives to this medicine?

If you have a fungal infection, you will need an antifungal medicine to treat the condition. You may, however, be able to prevent future infections, and prevent your infection spreading to other people. For example, if you have athlete's foot, avoid sharing socks or shoes, don't walk barefoot in public bathrooms or around swimming pools and try not to scratch your rash as you may spread the infection to other parts of your body.

Resources and support

SA Health have information about fungal infections, including how to recognise and prevent them.