Version July 2025
| Azoles* | Echinocandins¶ | Amphotericin BΔ | |||||
| Fluconazole | Itraconazole | Voriconazole | Posaconazole | Isavuconazole | |||
| Candida albicans, Candida dubliniensis, Candida parapsilosis, Candida tropicalis | |||||||
| Candida lusitaniae | ◊ | ||||||
| Candida glabrata | |||||||
| Candida krusei | |||||||
| Candida auris | |||||||
| Cryptococcus spp | § | ||||||
| Histoplasma spp | |||||||
| Blastomyces spp | |||||||
| Coccidioides spp | |||||||
| Paracoccidioides spp | |||||||
| Sporothrix spp | Unknown | ||||||
| Talaromyces marneffei | |||||||
| Aspergillus fumigatus | § | ||||||
| Aspergillus terreus | § | ||||||
| Mucorales (eg, Mucor spp, Rhizopus spp) | |||||||
| Fusarium spp | ¥ | ||||||
| Color key: | |||||||
| The drug has no activity against the pathogen | |||||||
| The drug has intrinsic activity but there are high rates of acquired resistance to this drug‡ | |||||||
| The drug has activity against the pathogen | |||||||
This table provides an overview of antifungal spectrum of activity based on in vivo studies and/or use of these agents in clinical practice. This table is not inclusive of all fungi or all antifungal agents. For information on fungi not listed here (eg, Scedosporium, Lomentospora, Trichosporon), refer to the UpToDate topics on these pathogens.
Antifungal activity against a specific pathogen varies based on local susceptibility patterns. This table does not provide guidance on empiric antifungal use against specific fungi; some fungi that are listed as susceptible to a certain antifungal should not be treated with that antifungal until susceptibility is confirmed. Additionally, effectiveness of the antifungal against a certain fungus in a specific patient varies significantly with the pharmacokinetics of the drug, the location of infection, as well as other patient-specific characteristics. Refer to UpToDate topics on specific pathogens and/or syndromes for more details on choosing the optimal antifungal regimen for treatment of a clinical syndrome and/or fungal infection.
* Azoles target the fungal cell membrane by inhibiting the synthesis of ergosterol.
¶ Echinocandins weaken the fungal cell wall by inhibiting beta-D-glucan synthesis.
Δ Amphotericin B targets ergosterol weakening the cell membrane, resulting in leakage and ultimately death of the fungal cell.
◊ May develop resistance during therapy. Refer to topic on treatment of candidal infections for further details.
§ These antifungal agents are typically used as part of combination therapy in treating these infections. Refer to UpToDate topics on specific pathogens for guidance on treatment and antifungal selection.
¥ Although in vitro studies demonstrate Fusarium spp resistance to amphotericin B, clinical studies have shown clinical improvement with amphotericin B treatment of invasive Fusarium infections.
‡ Intrinsic activity against pathogen is present but there are high rates of acquired resistance that often precludes use of drug for treatment of this pathogen. Confirm susceptibility prior to use. Refer to appropriate UpToDate topic prior to using this agent for treatment for this pathogen.
