Anti-infective
Systemic antifungals
Echinocandins and amphotericin (severe infections) — Hospital antifungal drugs for serious, invasive fungal infections — beyond the everyday azoles and creams.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
Quick answer
What is Systemic antifungals?
These are the stronger antifungal medicines used in hospital for serious, invasive fungal infections — those affecting the blood, lungs or deep tissues — rather than the everyday skin, nail and thrush infections treated with azoles and creams. They are usually given by drip under specialist care.
- How it works: They attack structures unique to fungal cells: echinocandins block the building of the fungal cell wall, while amphotericin binds the fungal cell membrane and punches holes in it.
- In practice: In practice these are the heavier-duty antifungals used for serious, invasive fungal infections (in the blood, lungs or deep tissues), typically in people who are very unwell or immunocompromised — after transplants, with blood cancers, or in intensive care — complementing the oral azoles and topical antifungals covered elsewhere.
What it is
These are the stronger antifungal medicines used in hospital for serious, invasive fungal infections — those affecting the blood, lungs or deep tissues — rather than the everyday skin, nail and thrush infections treated with azoles and creams. They are usually given by drip under specialist care.
How it works
They attack structures unique to fungal cells: echinocandins block the building of the fungal cell wall, while amphotericin binds the fungal cell membrane and punches holes in it. Targeting fungus-specific structures lets them kill the infection, though amphotericin's membrane action also affects the kidneys, which underlies its toxicity.
In practice
In practice these are the heavier-duty antifungals used for serious, invasive fungal infections (in the blood, lungs or deep tissues), typically in people who are very unwell or immunocompromised — after transplants, with blood cancers, or in intensive care — complementing the oral azoles and topical antifungals covered elsewhere. The two main groups have distinct practical profiles. Echinocandins (such as caspofungin) are given by drip, are generally well tolerated, and are often a first choice for invasive candida infections. Amphotericin is a powerful, broad agent for severe fungal infections but is more toxic: it can harm the kidneys and disturb electrolytes (especially potassium and magnesium), and cause infusion reactions (fever, chills) — risks much reduced by the modern lipid formulations and by hydration and monitoring. Across both, the themes are: confirm the diagnosis and choose by the likely fungus and site, monitor kidney function and electrolytes (particularly with amphotericin), watch for interactions, and step down to an oral agent when the person improves. These are specialist, hospital-initiated treatments, and duration is often prolonged and guided by the infection and the person's immune recovery.
Examples
Practical use
How to take it & use it well
- These are powerful antifungal treatments given by drip in hospital for serious infections that have spread inside the body.
- They are given and monitored by a specialist team, who watch closely during and after each infusion for any reaction.
- If you are having amphotericin, the team will often give fluids and monitor your kidneys and salts carefully, as it can affect both.
- Reactions during the drip, such as fever, chills or shivering, are managed by the team, sometimes by slowing the infusion or giving other supportive medicines.
- Once the infection is improving, you may be stepped down to antifungal tablets to complete treatment, which is a normal and welcome part of recovery.
- Tell the team about your other medicines and any new symptoms, as these treatments interact with several drugs and need close monitoring.
Common uses
- Invasive candida and other serious fungal infections
- Fungal infection in immunocompromised or critically ill patients
- Severe infections where oral antifungals are not enough
Monitoring
- Kidney function and electrolytes (especially with amphotericin)
- Infusion reactions, liver function and blood counts
- Clinical response and step-down to oral therapy
Weighing it up
Advantages & disadvantages
Advantages
- They treat serious, invasive fungal infections that can be life-threatening if untreated.
- Echinocandins are usually well tolerated and are often a first choice for serious thrush-type infections in the blood.
- Lipid forms of amphotericin are gentler on the kidneys than the older preparation.
- They allow treatment to begin in hospital and often step down to tablets later.
- They are given by specialist teams who tailor the choice to the infection and the person.
Disadvantages
- Amphotericin can harm the kidneys and disturb the body's salts, so close monitoring is essential.
- Amphotericin can cause infusion reactions such as fever, chills and shivering as it is given.
- They are hospital treatments given by drip, at least to begin with, rather than simple tablets.
- They can interact with several other medicines, so the full treatment list must be reviewed.
- Treatment for serious infections can be lengthy, requiring patience and monitoring.
Key safety principles
What to watch for
- Amphotericin can harm the kidneys and disturb electrolytes (potassium, magnesium) and cause infusion reactions — hydration, lipid formulations and monitoring reduce this.
- Echinocandins are generally well tolerated and often first-line for invasive candida.
- Specialist, hospital-initiated; choose by the likely fungus and site, watch interactions, and step down to oral treatment on improvement.
Key interactions
What to avoid or check alongside
- Amphotericin can harm the kidneys and disturb salts such as potassium and magnesium, so the kidneys and salts are monitored and fluids often given.
- Lipid formulations and good hydration reduce, but do not remove, the kidney risk with amphotericin.
- Echinocandins are generally well tolerated and are often used first for invasive candida infections, with fewer drug interactions.
- These treatments can interact with several other medicines, so your full list, including anything new, must be reviewed by the team.
- Once the infection is under control, treatment is often stepped down from the drip to oral antifungals to complete the course.
Patient & carer advice
- These are strong antifungals for serious infections, given by drip in hospital
- You will have regular blood tests to watch your kidneys and salts, especially with amphotericin
- Tell the team about any reaction during the infusion or any other medicines you take
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
Systemic antifungals: frequently asked questions
What are these antifungals used for?
They treat serious fungal infections that have got into the blood or deep inside the body, which can be life-threatening. Because these infections are serious, the treatments are usually started by drip in hospital under a specialist team, with close monitoring, before stepping down to tablets later.
Why does amphotericin need so much monitoring?
Amphotericin can affect the kidneys and unbalance the body's salts, and it can cause reactions such as fever and chills while it is given. The team monitors your kidneys and salts, often gives fluids, and uses gentler lipid forms where possible, all to keep treatment as safe as it can be.
Are echinocandins safer than amphotericin?
Echinocandins are generally well tolerated, with fewer effects on the kidneys and fewer drug interactions, which is why they are often a first choice for serious candida infections in the blood. The best treatment depends on the type of infection, so the team chooses what suits your situation.
Why am I being switched from the drip to tablets?
Stepping down from the drip to antifungal tablets, once the infection is improving and you are more stable, is a normal and positive part of recovery. It often means you can complete treatment more comfortably, and sometimes at home. Your team decides when it is safe to switch.
What happens if I get a reaction during the infusion?
Reactions such as fever, chills and shivering can happen as amphotericin is given. The team is ready for this and manages it, often by slowing the drip and giving supportive medicines. Tell them straight away if you feel unwell during an infusion so they can act quickly.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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