Table 3.

Classification and mechanism of action of antifungal antibiotics ¹⁸ , ³² , ³³ , ³⁴

Class	Drug	Mechanism of action	Mode of action	Side effects	References
Azoles (Imidazoles)	Clotrimazole	Inhibition of fungal lanosterol 14 demethylase causes ergosterol depletion then sterol build‐up in the fungal cell membrane, which is dangerous	Fungistatic, fungicidal	Local irritation, allergic reactions	[ 34 ]
	Ketoconazole			Hepatotoxicity	[ 19 ]
	Miconazole			Liver damage, nausea, arrhythmias, pruritus, hyponatraemia, hyperlipidaemia, dyscrasias	[ 34 ]
Azoles (Triazoles)	Fluconazole	Ergosterol production is inhibited, resulting in a decrease in the integrity and activity of fungal cell membranes	Fungistatic, fungicidal	Hepatic toxicity, increased plasma concentrations of (topical/oral) anaphylaxis, stevens‐Johnson syndrome, hypokalaemia, exfoliative skin disorders, agranulocytosis, thrombocytopenia, toxic epidermal necrolysis, adrenal cortex dysfunction	[ 34 ]
	Itraconazole			Liver function (but hepatotoxicity is milder than ketoconazole, and hypokalaemia with hypertension is caused by corticosteroids with aldosterone‐like action accumulating. Nausea, epigastric discomfort, headache, and edema are all symptoms of leukopenia. Causing heart failure in patients who are elderly or on calcium channel blockers	[ 19 ]
	Efinaconazole
				Oral burning, xerostomia, altered taste, minor GI‐upset followed by oral ingestion of the drug, allergic reactions
Allylamines	Naftifine	Squalene epoxidase inhibition: activity linked to squalene accumulation's harmful consequences	Fungistatic	Burning, erythema, dryness, itching	[ 35 ]
	Terbinafine	It inhibits squalene epoxidation, a key initial stage in the formation of ergosterol, by functioning as a noncompetitive inhibitor of fungal squalene epoxidase	Fungistatic, fungicidal	Hepatobiliary dysfunction, induction, agranulocytosis, exacerbation of lupus, severe skin reactions	[ 36 ]
Benzylamines	Butenafine	Interferes with ergosterol production by blocking the enzyme squalene 2, 3 epoxidase, which converts squalene to squalene oxide	Fungicide		[ 16 ]
Polyenes	Amphotericin B	It's an antifungal that's classified as “polyene.” Polyenes bond to ergosterol found in fungi (the primary sterol in fungal cell membranes). The permeability of the cell membrane is altered, and intracellular components seep out of the cell. Depending on the level of concentration in the body	Fungistatic, fungicidal	Serum creatinine, complete blood counts, serum magnesium, blood urea nitrogen, serum sodium, serum potassium, liver function test result must be monitored. When it is used with amino glycosides or neuromuscular blockers, prolonged skeletal muscle paralysis	[ 19 ]
	Nystatin	It's a polyene‐based antifungal that exclusively effects on Candida	Fungicidal	GI‐ upset is common when nystatin is taken orally	[ 19 ]