This page summarizes primary and alternative drugs for the treatment of specific fungal infections. This page focuses on medical therapeutic approaches and it must be remembered that other therapeutic measures (most commonly, surgical excision and debridement) are required in combination with antifungal therapy for some fungal infections. Please refer to the related page about each fungal infection for additional data.

Please also see our discussion on cost analysis and pharmacoeconomic analysis of antifungal therapy.

The tables are presented in two sections. The first table shows drugs of choice and the second table shows suitable dosages. These abbreviations are used throughout the tables:

  • AMB: Amphotericin B deoxycholate (Fungizone)
  • ABLC: Amphotericin B lipid complex (Abelcet)
  • ABCD: Amphotericin B colloidal dispersion (Amphotec)
  • LAMB: Liposomal amphotericin B (AmBisome)
  • Echinocandin: Caspofungin, micafungin or anidulafungin

Drugs of Choice

The following table summarizes the therapeutic options in the more frequent systemic fungal infections [85, 99, 114, 291, 421, 525, 795, 946, 1000, 1001, 1003, 1168, 1406, 1623, 1737, 1915, 1934, 1993, 2163, 2290, 2415]. Some of the treatment modalities have not been formally approved by the US Food and Drug Administation.

Aspergillosis Voriconazole Itraconazole
An AMB preparationa Echinocandin
Itraconazole (used in milder forms or after more severe disease is stabilized with an AMB preparation)a Posaconazole
Blastomycosis An AMB preparationa Ketoconazole
Itraconazole capsule (for mild to moderate disease) Fluconazole PO
Candidemia and invasive candidiasis Echinocandin

An AMB preparationa

Fluconazoleb IV or PO ABCD


Oropharyngeal candidiasis Fluconazoleb PO Ketoconazole


Clotrimazole troche

Nystatin oral suspension

AMB oral suspension


Esophageal candidiasis Fluconazoleb PO Ketoconazole




Vulvovaginal candidiasis Fluconazoleb, e PO single dose Ketoconazole
Topical azole preparations Itraconazole
Nystatin vaginal tablet Boric acid
Coccidioidomycosis An AMB Ketoconazole
preparationa (for rapidly progressive disease) Itraconazole



Fluconazole PO or IV (for subacute/chronic disease or coccidioidal meningitis) AMB intrathecalf
Cryptococcosis An AMB preparationa+Flucytosine LAMB



Chronic suppressive therapy with fluconazole PO in AIDS patients (lifelong) Itraconazole capsule

Chronic suppressive therapy with itraconazole capsule or AMB (weekly) in AIDS patients (lifelong)

Dermatophytosisg (other than dermatophytic onychomycosis) Terbinafine Griseofulvin
Itraconazole capsule Fluconazole Topical therapy
Histoplasmosis AMB (for severe disease) ABLC
Itraconazole (for mild to moderate disease) ABCD




Chronic suppressive therapy with itraconazole capsule in AIDS patients (lifelong) Chronic suppression therapy with itraconazole capsule, fluconazole PO or AMB (weekly) in AIDS patients (lifelong)
Candida onychomycosis Itraconazole capsule
Dermatophytic onychomycosis Terbinafine Griseofulvin
Itraconazole oral capsule Topical cicloprox olamine


Paracoccidioidomycosis An AMB preparationa
Itraconazole (for mild to moderate disease)
Pseudallescheriasis Voriconazole




Cutaneous and lymphocutaneous sporotrichosis Itraconazole Potassium iodide

Fluconazole PO

Systemic sporotrichosis An AMB preparationa (for severe disease)

Itraconazole (for mild to moderate disease)

Chronic suppressive therapy with itraconazole capsule in AIDS patients (lifelong)

Fluconazole PO
Zygomycosis An AMB preparationa Posaconazole


a. The lipid formulations of amphotericin B are licensed for use in patients whose infection is intolerant or refractory to amphotericin B deoxycholate treatment. However, a lipid AMB (ABLC, ABCD, or LAMB) can generally be substituted and is often preferred for mould infections.

b. Fluconazole should not be used in any clinical form of candidiasis due to Candida krusei as this species is felt to be intrinsically resistant to fluconazole. For other Candida spp., such as Candida glabrata, in vitro antifungal susceptibility test results may be used to determine whether the infecting strain is susceptible to fluconazole. See our discussion of the usual susceptibility patterns of Candida spp.

c. Indicated only in azole-refractory or azole-resistant infections.

d. Caspofungin has activity here, but is not licensed for this indication. Limited safety data exist for caspofungin and the risk/benefit ratio for its use here would need to be carefully evaluated.

e. 150 mg single dose therapy.

f. May be indicated in patients who do not respond to fluconazole.

g. In patients with widespread skin lesions and tinea capitis, oral therapy is indicated since topical therapy frequently fails.


Below are the generally recommended doses of systemically administered antifungal agents. The optimal dose may need to be modified depending on the severity of the infection as well as the immune status of the host. Thus, the recommendations below are not strict and their use requires cautious individual evaluation of each patient.

AMB 0.6-1.5 mg/kg/day IV (doses above 1 mg/kg/d tend to be highly nephrotoxic and must be administered with great caution)
10 µg intravitreal
Oral suspension
100 mg (1 ml) four times daily
ABCD 3-4 mg/kg/day IV
ABLC 5 mg/kg/day IV
LAMB 3-6 mg/kg/day IV
Boric acid 600 mg gelatin capsule once daily intravaginal



Loading dose of 70 mg/day, followed by 50 mg/day IV

50-150 mg/day

Loading dose of 100-200 mg/day, followed by 50-100 mg/day

Clotrimazole troche 10 mg five times daily PO
Fluconazole 100-800 mg once/bid PO
150 mg PO single dose therapy (for vulvovaginal candidiasis)
400-800 mg IV
Flucytosine 25 mg/kg qid PO
Griseofulvin 10-20 mg/kg/day PO tablet/syrup
Itraconazole 200-400 mg capsule once/bid PO
Oral solution 200 mg (20 ml) once daily
Voriconazole 6 mg/kg q12h day#1, the 3-4 mg/kg/q12h IV
200 mg qid PO
Posaconazole 800 mg/day PO divided doses (bid-qid)
Ketoconazole 400-800 mg once/bid PO
Nystatin 500,000 U (5 ml) oral suspension four times daily PO
100,000 U vaginal tablet once daily
Potassium iodide (saturated solution) 1-5 ml tid PO
Terbinafine 250 mg/day PO