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12.1 Azoles
The azoles may be considered as two subgroups: the
older
imidazole drugs, the majority of which were introduced
as topical products or pessaries for the treatment of
superfi
cial infections by dermatophytes (skin pathogens),
Pityriasis species (causing fl aky skin and dandruff)
and C.
albicans , and the more recently developed, more
versatile
and, in some cases, much more expensive, triazoles.
Imidazoles
The imidazoles are a large and diverse group
of compounds
with activity against bacteria and protozoa
(metronidazole
and tinidazole), helminths (mebendazole)
and
fungi (clotrimazole, miconazole,
ketoconazole, econazole,
sulconazole and tioconazole).
Triazoles
Fluconazole (Figure 11.12 A) and itraconazole
were introduced
in the 1980s and posaconazole and voriconazole
much more recently.
Fluconazole is better absorbed from the
gastrointestinal
tract than itraconazole and, in addition to the
treatment
of dermatophytes, pityriasis and Candida
infections,
Polyenes
Polyene antibiotics are characterized by
possessing a large
ring containing a lactone group and a
hydrophobic
region consisting of a sequence of four to
seven conjugated
double bonds. The only important polyenes
are
amphotericin B and nystatin.
Echinocandins
The echinocandins are a new class of
semisynthetic
lipopeptide antibiotics that are
fungicidal towards
Aspergillus spp., Candida spp. and
Pneumocystis jirovecii
(previously known as P. carinii ).
Antiviral d rugs
HIV
There is a large and progressively
increasing variety of
antiretroviral agents available to
treat HIV, and their
use requires specialist knowledge
Viral h epatitis
Hepatitis, infl ammation of the liver,
can be caused by
various drugs and to xins, but
hepatitis due to viral infection
is more common.