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Antifungal agents are available in systemic and topical formulations, and some are available in both forms. Topical antifungal agents, because they are poorly absorbed, are less likely to cause toxicity and should, as a rule, be the first choice for treating skin and mucous membrane infections. However, tinea capitis and onychomycosis (fungal infection of the nails) are best treated systemically (see Chapter 367). Infections that are severe, are disseminated, or involve the bloodstream should also be treated with systemic therapy. During the past 10 years, many potent new systemic agents have become available. Organism- and disease-specific antifungal therapies are summarized in Table 247-1.

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Table 247-1. Antifungal Therapy 

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