Which drug works by creating pores in the fungal cell membrane?

Amphotericin B is the drug that works by creating pores in the fungal cell membrane. This antifungal agent belongs to the polyene class and exerts its effects by binding to ergosterol, a key component of fungal cell membranes. The binding of Amphotericin B to ergosterol leads to the formation of membrane pores, which disrupts the cell's integrity and allows for the leakage of vital cellular components. This results in cell death and is particularly effective against a wide range of fungi, making it a critical treatment option for serious fungal infections.

The mechanism of action of Amphotericin B sets it apart from the other drugs listed. Fluconazole, for instance, works by inhibiting the enzyme lanosterol 14α-demethylase, which is involved in the synthesis of ergosterol, thus impairing membrane integrity but not by creating pores. Anidulafungin is an echinocandin that inhibits the synthesis of beta-1,3-D-glucan, an essential component of the fungal cell wall, rather than affecting the cell membrane. Flucytosine, on the other hand, is an antimetabolite that disrupts fungal nucleic acid synthesis, leading to cell growth inhibition.