What are antifungal medicines?

Antifungal medicines (also called antifungals) are medicines used to treat fungal infections.

Some antifungals are applied directly to your skin, mouth, nails or vagina. Others are taken as a tablet or injection.

Which conditions are antifungal medicines used for?

Common fungal infections include:

• Tinea — an infection found in moist, warm parts of your body. Tinea causes athlete's foot, ringworm of the scalp and body, jock itch and nail infections.
• Thrush — an infection caused by overgrowth of a fungus called Candida. You can get thrush in your mouth, vagina or on your genitals.
• Seborrhoeic dermatitis — can lead to dandruff or cradle cap.

Anyone can get a fungal infection. They usually get better with simple treatment applied directly to the infected area.

In some cases, you may need a tablet or capsule to treat a fungal infection.

In rare cases, a severe fungal infection can get inside your body. This is called a systemic infection. A systemic fungal infection can affect your blood and organs. Systemic infections are more likely if you have a weakened immune system. If you have a fungal infection in your blood or organs, your doctor may prescribe antifungal medicine as an injection or use more than one medicine. This treatment is usually started in hospital.

How do antifungal medicines work?

Antifungals can be either:

• 'Fungistatics' that stop the fungus from growing normally so your body's immune system can break them down. These include griseofulvin, and azoles such as clotrimazole and fluconazole.
• 'Fungicidals', such as terbinafine, that kill the fungus and stop the infection.

Some infections take longer to treat than others. How long you need treatment will also depend on how severe your infection is.

You will usually need 1 to 2 weeks of treatment with a cream to treat a skin infection.

Some nail infections can take up to 12 months to get better.

Use your antifungal medicines regularly to properly treat the infection.

It's important to keep using creams for tinea infections for 2 weeks after the signs of infection have gone. This is because most of these creams only slow the growth of the fungus but do not kill it. Using them for a while after the infection seems to be gone will help prevent the infection coming back.

Check with your pharmacist or doctor about how long you should continue antifungal treatment.

What types of antifungal medicines might I need?

Different types of antifungal medicine are used for different parts of your body.

You might need:

• a cream, ointment or powder for a skin infection or genital thrush
• oral drops, gel or lozenges for thrush in your mouth
• a pessary (vaginal tablet) or cream for thrush in your vagina
• nail paint or tablets for an infection of your fingernails or toenails
• a shampoo for seborrhoeic dermatitis on your scalp

Topical antifungals can be applied directly to an infection on your:

• skin
• mouth
• vagina
• nails

Other antifungal medicines that work throughout your body are taken as a tablet, capsule or injection.

If you have a weakened immune system, you are more likely to need a tablet or capsule to treat a fungal infection.

You may have a weakened immune system if you have a chronic condition such as cancer, arthritis, asthma, diabetes, HIV or inflammatory bowel disease. Cancer treatments and medicines for organ transplants or autoimmune diseases can also weaken your immune system.

Do I need a prescription for antifungal medicines?

You can buy creams and powders for skin infections such as athlete's foot, or shampoo for dandruff, from a pharmacy or supermarket.

You will need to speak to a pharmacist to buy:

• internal creams, pessaries and other treatments like oral fluconazole for vaginal thrush
• gels and drops for oral thrush, which is an infection in your mouth
• treatments for fungal nail infections

You need a prescription from your doctor for most antifungal capsules and tablets.

What are the side effects of antifungal medicines?

Topical antifungals don't usually cause serious side effects. Some treatments used on your skin might make the area feel irritated.

Some antifungal medicines taken by mouth (capsules and tablets) can cause stomach upsets — ask your pharmacist or doctor if you should take them with food.

Speak to your doctor or pharmacist before taking antifungal medicines (including creams) if you are pregnant or breastfeeding. Some antifungal medicines can harm your fetus (baby).

If you get side effects or if the infection does not get better, speak to your doctor. You may need a different treatment. Your condition may not be caused by a fungal infection.

Azole antifungals

If you take azoles like fluconazole, itraconazole or voriconazole in tablet or capsule form, they may cause:

• stomach upset or nausea
• abdominal (tummy) pain
• rash
• headache
• liver problems
• changes to your vision

It is important that you tell your doctor or pharmacist if you are taking any other medicines. Some antifungal medicines can change how medicines work when they are taken together. This can happen when you take azoles and it might stop one of your medicines from working properly or cause unexpected side effects.

Your doctor may avoid prescribing an azole antifungal or use a low dose if you have:

• liver disease
• heart failure
• kidney disease

Terbinafine

Terbinafine tablets may cause:

• stomach upset, nausea or diarrhoea
• skin rash or itch
• muscle aches
• headache
• changes to how things taste

You shouldn't take terbinafine if you have severe liver disease. Tell your doctor about any liver problems and other health conditions that you have.

Are there any alternatives to antifungal medicines?

If you have a fungal infection, you will need an antifungal medicine to treat it. Your doctor will look at where the infection is and how severe it is and recommend a treatment.

If you have a fungal nail infection, you might need to have the nail removed.

You may be able to prevent future infections and prevent your infection from spreading to other people. If you have athlete's foot, avoid sharing socks or shoes and don't walk barefoot in public bathrooms or around swimming pools. Try not to scratch your rash as you may spread the fungal infection to other parts of your body.

When should I see my doctor?

Ask your doctor or pharmacist which type of treatment is best for you and how long you should take them for.

It is important that you tell your doctor or pharmacist if you are taking any other medicines. Antifungals can cause serious problems if taken with some other medicines.

If you are pregnant or breastfeeding, speak to your doctor or pharmacist before taking antifungal medicines (including creams). Some antifungal medicines can harm your fetus (baby).

If you are prescribed antifungal medicines that are taken by mouth, ask your pharmacist or doctor if you should take them with food to help avoid an upset stomach.

If you get side effects or if the infection does not clear up, speak to your doctor. You may need a different treatment. Your condition may not be caused by a fungal infection.

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

Resources and support

You can read more about treating common fungal infections.

• The Australasian College of Dermatologists has information about tinea and athlete's foot.
• The Australian Podiatry Association has information about nail infections.
• Jean Hailes for Women's Health has information about vulval and vaginal thrush.
• Healthy Male has information about jock itch.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.