This episode explores antifungal agents as the pharmacology of narrow discrimination. Fungi are eukaryotes-biologically closer to us than bacteria-so effective therapy depends on exploiting small but crucial differences in cell membranes, cell walls, and replication machinery. We examine ergosterol synthesis and binding, cell wall β-glucan inhibition, nucleic acid synthesis interference, and emerging resistance to understand why antifungal treatment is often prolonged, toxic, and indication-specific. The clinical thread is proportionality: choosing enough power to clear infection without tipping into host harm.
Key takeaways to stabilise understanding:
* Eukaryotic challenge: why selective toxicity is harder with fungi.
* Membrane targets: azoles, polyenes, and ergosterol disruption.
* Cell wall strategy: echinocandins and β-glucan synthesis inhibition.
* Resistance and relapse: biofilms, non-albicans species, and adaptive pathways.
* Clinical judgement: superficial vs invasive disease, host immunity, and duration.
