fungal infection
DESCRIPTION
PPTTRANSCRIPT
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FUNGAL INFECTIONS
Fungal infection Treatment
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Most common fungal
infections
1- Candidiasis
It is caused by infection with species of the
genus Candida, predominantly with Candidaalbican
Types:
candidiasisVaginal-a
Presentation:-
1- Itching and irritation in the vaginal area.
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1- Candidiasis
2-A burning sensation, especially during intercourse orwhile urinating
3-Redness and swelling of the area
4-Vaginal pain and soreness
5-Thick, white, odor-free vaginal discharge with acottage cheese appearance
1-Treatment:
1- mild to moderate symptoms and infrequentepisodes of infection
a-Short-course vaginal therapy:
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Candidiasis
- one-to-three-day regimen of an antifungal cream,
ointment, tablet or suppository
-The medication of choice is azole antifungal
family:butoconazole, clotrimazole ,miconazole and
terconazole .
The oil-based nature of these agents in cream
and suppository form can weaken latex condoms
and diaphragms
-Side effects :
A- sli ht burnin or irritation durin a lication
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Candidiasis
B- Single-dose oral medication fluconazole (Diflucan) to
be taken by mouth.
2- Treatment for a complicated cases
a- Long-course vaginal therapy includes an azole
medication in the form of a vaginal cream, ointment,
tablet or suppository. The duration of treatment is
usually seven to 14 days.b- Multidose oral medication instead of vaginal
therapy: two or three doses of fluconazole to be taken
by mouth.
***this therapy isn't recommended for pregnant
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Candidiasis
c- Maintenance therapy: For recurrent infections
- It starts after the initial treatment clears infection
-It include:I-fluconazole tablets taken by mouth once a week for
six months.
II- Clotrimazole as a vaginal tablet (suppository) used
once a week instead of an oral medication
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Candidiasis
b- Oropharyngeal candidiasis
Presentation
I-Children and adults
a-Creamy white lesions on tongue, inner cheeks
and on the roof of mouth, gums and tonsils
b-Lesions with a cottage cheese-like appearance
c-Pain
d-Slight bleeding if the lesions are rubbed orscraped
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Candidiasis
e- Cracking and redness at the corners of the mouth
f- Loss of taste
II- Infants and breast-feeding mothers
a- white mouth lesions
b- infants may have trouble feeding or and irritable.
c- Unusually red, sensitive or itchy nipples
d- Unusual pain during nursing or painful nipplesbetween feedings
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Candidiasis
Treatment
A- For infants and nursing mothers
1- A mild topical antifungal medication for baby andmother.
Example: miconazole
2- If baby uses a pacifier or feeds from a bottle, rinsenipples
and pacifiers in a solution of equal parts water andvinegar
daily and allow them to air dry to prevent fungus growth.
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Candidiasis
B- For healthy adults and children
1-Eating unsweetened yogurt
2-Taking acidophilus capsules or liquidYogurt and acidophilus don't destroy the fungus,
but they can help restore the normal bacterial flora
in the body.
3-If infection persists, Topical antifungal medication
can be used
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Candidiasis
C- For adults with weakened immune systems
1-Antifungal medication ( lozenges, tablets or a
liquid that can be swish in mouth and then
swallow). Example: nystatin.
2-Amphotericin B that can be used when other
medications aren't effective.
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Candidiasis
C- skin lesion
-Presentation:
1-itching
2- Red and growing skin rash. This rash withdiscrete
borders
3- Rash usually appear on the skin
folds, genitals, middle of the body,
buttocks, and under the breasts
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Candidiasis
-Treatment:
1-Topical azole antifungal: clotrimazole
(Canesten ), econazole (Pevaryl),
ketoconazole( Nizoral), miconazole (Dactarin )
2-topical terbinafine (Lamisil )
3-Topical nystatin
4-Refractory cases: need systemic treatment withazole ( fluconazole)
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1. Candidiasis
D- Disseminated candidiasis:
This is frequently associated with multiple deep
organ infections or may involve single organinfection.
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2- Dermatophytoses
2-Dermatophytoses
a-tinea capitis :Superficial fungal infection of the
skin of the scalp, eyebrows, and eyelashes,
- Presentation
1-One or more round
patches of scaly skin
2-Scaly, gray or reddened
areas
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2- Dermatophytoses
3-Patches have small black dots where the
hair has broken off at the scalp
4-Tender or painful areas on the scalp
- Treatment:
1-Drug of choice : Systemic administration of
Griseofulvin
Recommend dose:
20-25 mg/kg/d for 6-8 weeks
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2- Dermatophytoses
2-Topical treatment alone is not recommended
because it is ineffective
3-alternative systemic therapy:ketoconazole, itraconazole, terbinafine, and
fluconazole (itraconazole and terbinafine are used
most commonly)
4-Selenium sulfide shampoo may reduce the riskof
spreading the infection
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2- Dermatophytoses
b-Tinea coropris ( ringworm infection of thebody )
it is a superficial dermatophyte on the on the
top layer of your skin (skinregions other than the scalp,
groin, palms, and soles).
Presentation
1- A ring-shaped rash that is
itchy, red, scaly and slightly
raised.
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2- Dermatophytoses
2- The rings usually flat scaly area on the skin,
which
may be red and itchy.
- Treatment
1- antifungal lotion or cream
***Topical therapy should be applied to the
lesion and at least 2 cm beyond this area once
or twice a day for at least 2 weeks
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2- Dermatophytoses
a- The topical azoles (econazole, ketoconazole,
clotrimazole, miconazole, oxiconazole,
sulconazole, sertaconazole)
b-Luliconazole (Luzu) is an imidazole topical
cream approved by the FDA in November 2013 for
treatment tinea corporis
FDA approves luliconazole for treatment of tinea
corporis
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2- Dermatophytoses
FDA recently approved the azole antifungal
luliconazole 1% cream the first topical azole
antifungal
agent with a 1-week (rather than 2-week), once-daily
treatment regimen for the management of tinea
cruris
and tinea corporis in adults aged 18 years or
older.
Luliconazole was also approved for the treatment
of
interdi ital tinea edis in adults a re imen that
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2- Dermatophytoses
Allylamines (eg, naftifine, terbinafine)-c
2- Severe cases need systemic therapy: griseofulvin, Systemic azoles (eg, fluconazole,
itraconazole, ketoconazole)
(athlete's foot )pedisTinea-c
It is a dermatophyte infection ofthe soles of the feet and the
interdigital spaces
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Athlete's foot
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2- Dermatophytoses
It occurs most commonly in people whose feet
have become very sweaty while confined within
tight-fitting shoes.
- Presentation
1- Scaly rash that usually causes itching, stinging and
burning.
2- Some cases: blisters or ulcers.
3- Some cases: chronic dryness and scaling on the
soles that extends up the sides of the feet
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2- Dermatophytoses
- Treatment:
1- Topical treatment:
a- imidazole:clotrimazole, econazole, miconazole,
ketoconazole and luliconazole) "Luliconazole, an
imidazole topical cream, is applied once daily for 2
weeks "b- Ciclopirox cream
c- terinafine and naftitine
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2- Dermatophytoses
2-oral drugs in severe cases : Itraconazole,
Terbinafine, and fluconazole
3-Topical urea to decrease scaling.
3 Pit i i i l ( Ti
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3- Pityriasis versicolor ( Tinea
versicolor)
- Presentation
- Hypopigmented or hyperpigmented macules
and
patches on the chest and the back.
- The color of each lesion varies
from almost white to reddishbrown or fawn colored. A fine,
dustlike scale covers the lesions.
3 Pit i i i l ( Ti
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3- Pityriasis versicolor ( Tinea
versicolor)
- Treatment:
1-Clotrimazole cream or lotion
2-Miconazole cream
3- Ketoconazole and Selenium sulfide shampoo
4- Terbinafine (Lamisil) cream or gel
- InstructionsA thin layer of the topical agent applied once or twice
a day on affected area for at least two weeks.
4 F l il i f ti
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4- Fungal nail infections
(onychomycosis)
Onychomycosis is a fungal infection of thetoenails or
fingernails.
Causes:
1-Most common cause is Dermatophytes ( Tinea
ungum )
2-Candida (yeasts )
3- molds
4 F l il i f ti
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4- Fungal nail infections
(onychomycosis)
- Presentation:
There are different classifications
of nail fungus depending on type
of fungus and manifestation.
- Common symptoms:
1- A painful and erythematous area
around and underneath the nail
and nail bed
2- Nail thickening, ridging, discoloration, and
occasional nail loss
4 Fungal nail infections
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4- Fungal nail infections
(onychomycosis)
3-Infected nails may separate from the nail bed.
- Treatment :
1-Topical antifungal:
-Topical treatment used for mild to moderate cases
-Agents: Amorolfine (Loceryl), Ciclopirox (Mycoster) .
2-Oral medication:
Most effective treatments are terbinafine (Lamisil)
and itraconazole (Sporanox)
4 F l il i f ti
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4- Fungal nail infections
(onychomycosis)
Oral medication recommended for:
1- DM patients
2- If patient has cellulitis or history of cellulitis3- If patient has pain or discomfort from nail infection
- These Drugs help growing a new nail free of
infection,slowly replacing the infected portion of nail. these
medications will be taken for six to 12 weeks, andthe end
result of treatment seen after the nail grows back
4 Fungal nail infections
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4- Fungal nail infections
(onychomycosis)
To decrease the adverse effects and duration of
oral therapy, topical treatments may becombined with oral antifungal management
M t f l
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Most common fungal
infection s5- Aspergillosis
- Commonly affects respiratory tract
- Invasive forms can affect heart, brain and skin- Drug of choice: Voriconazole
6- Cryptococcosis
- Most common form: cryptococcal meningitis
Treatment : amphotericin B and flucytocine for 2
weeks then followed by fluconazole for 8 weeks or
until culture is positive
M t f l
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Most common fungal
infection s
7-histoplasmosis
Histoplasmosis is an infection caused by
breathing in
spores of a fungus often found in bird and bat
droppings
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Antifungal Drugs
I-Azole family:
- M.O.A
-Inhibit sterol synthesis in fungal cell membranes,
thislead to increase cell permeability and osmotic
pressure
- Drugs:
1-ketoconazole (Nizoral)
- System ic Ketoconazole
It has slow onset of action and need long durationof
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1- ketoconazole
- Off-label use :
1- Cushing syndrome :ketoconazole Inhibits
steroidogenes process through inhibiting P450enzymes includes the first step in cortisol
synthesis, cholesterol side-chain cleavage, and
conversion of 11-deoxycortisol to cortisol
2- Dose Range : 600-800 mg/day PO
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1- ketoconazole
Tablets are not recommended as first-line
treatment; should be used only when other
effective antifungal therapy is not effective or
tolerated and the potential benefits areconsidered to outweigh the potential of
hepatotoxicity
Usual dose range:-200-400 mg/day PO
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1- ketoconazole
Black Box Warnings
A-Hepatotoxicity has occurred with oral use,
including some fatalities or requiring liver
B-May cause QT prolongation
- Coadministration with dofetilide, quinidine,
pimozide, cisapride, methadone, disopyramide,
dronedarone, and ranolazine is contraindicated
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1- ketoconazole
- Ketoconazole can cause elevated plasma
concentrations of these drugs (by CYP3A4
inhibition)and may prolong QT intervals, sometimes
resulting in
life-threatening ventricular dysrhythmiassuch as
torsades de pointes
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Most common side effects:
- Nausea,vomiting,diarrhea, constipation, and
abdominal pain
- Rare : hepatotoxicity
Drugs interaction:
Enhance anticoagulant effects of warfarin
1- ketoconazole
Ketoconazole( nizoral) Potentially Fatal
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Ketoconazole( nizoral) Potentially Fatal
Liver Injury, Risk of Drug Interactions and
Adrenal Gland Problems
July 26, 2013Audience: Internal Medicine, Infectious Disease.
ISSUE: FDA is taking several actionsrelated to Nizoral
(ketoconazole) oral tablets, including limiting the drugsuse,
warning that it can cause severe liver injuries and adrenalgland
problems, and advising that it can lead to harmful drug
interactions with other medications. FDA has approvedlabel
changes and added a new Medication Guide to addressthese
safety issues. As a result, Nizoral oral tablets should not be
a-
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1- Ketoconazole
Topical Ketoconazole
- Indication and dose
1-Seborheic Dermatitis
a-Foam: apply to affected area q12hr for 4 wk
b-Cream: apply q12hr for 4 wk or until clear
c-Shampoo: apply twice weekly for 4 wk with at
least 3 days between each shampoo
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2-Tinea Versicolor
a-Shampoo: twice weekly for 4 wks allowing 3
days between shampoo
3-Tinea corporis, Tinea Cruris, Tinea pedis
Cream: Apply once daily to cover affected area for
2
weeks (6 weeks for tinea pedis)
1- Ketoconazole
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1- Ketoconazole
*** When combined with corticosteroid ,
ketoconazole is useful in treating :
Atopic dermatitis, diaper rash, eczema, and
psoriasis
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2-Fluconazole (Diflucan)
-It achieves good penetration into cerebrospinal fluidso can be used for treating fungal meningitis
- It excreted largely in the urine and can be used for
treating candiduria
Drugs interaction:-
1- Avoid concomitant use with cisapride andterfenadine
2- It increases level of phenytoin, warfarin,sulfonylurea and cyclosporine
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2-Fluconazole (Diflucan)
- Dose:
1-Oropharyngeal & esophageal candidiasis:
200mg , orally on first day then continue 100mg,
orally , daily
2-Vaginal candidiasis: 150mg as single dose
3-Cryptoccocal meningitis: 400mg, orally on day 1
then 200mg, orally daily4-Candida UTI: 50-200mg, orally, qday
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2-Fluconazole (Diflucan)
- Caution
1- Hepatotoxicity reported with use; use with
caution in patients with hepatic impairment
2- When driving vehicles or operating machines,
it should be taken into account that dizziness or
seizures may occasionally occur
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3- Itraconazole (Sporanex)
-Need acid media for optimal absorption
-It is potent CYP4503A4 inhibitor
* Doses
-Onychomycosis:
1-Fingernails: pulse dose regimen: 200mg, twice
daily
for 1 week, repeat the course after 3 week off-time
2-toenails with or without fingernails involvement:
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3- Itraconazole (Sporanex)
3- Oral candidiasis: oral solution: 100-200 mg/dayfor at least 3 weeks, continued for 2 weeks aftersymptom resolution
Drugs interaction:- avoid co-administration with antacids, H2-
blockers
and proton pump inhibitors
- Containdicated with cisapride, dofetilide, ergot
derivatives, lovastatin, simvastatin, quinidine, and
triazolam
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3- Itraconazole (Sporanex)
Black Box Warning
Congestive heart failure-1
Negative inotropic effects reported with IVadministration; reassess therapy if signs or
symptoms of CHF occur during administration
Onychomycosis-2
Onychomycosis treatment contraindicated in
patients with ventricular dysfunction or history
of heart failure.
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3- Itraconazole (Sporanex)
Caution
-Discontinue if liver disease develops, and perform
liver
function tests; readministration discouraged
" Itraconazole is contraindicated for treating
onychomycosis in pregnant or intend on becoming
pregnant "
Most common side effects
- Nausea
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4-Voriconazole (Vfend)
- Broad spectrum antifungal and used in lifethreatening infection and refractory cases
Dose:
Esophageal candidiasis: 200mg, orally, q12hrs
*** Take oral form 1 hr before or after meal
Most common side effects:
Visual changes (photophobia, color changes,increased
or decreased visual acuity, or blurred vision occurin
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4-Voriconazole (Vfend)
Warning:
Avoid intense or prolonged exposure to direct
sunlight; in patients with photosensitivity skinreactions, squamous cell carcinoma of the skin
and melanoma have been reported during long-
term therapy
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5- Posaconazole
- licensed for treatment of invasive cases
unresponsive to conventional therapy
-Food increases oral availability so preferred to take
the dose with full meal
-Most common side effects
nausea & headache
-Drugs interactions:
1-avoid concomitant use with cimetidine, phenytoin,
and rifbutin
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5- Posaconazole
2- Coadministration with sirolimus; increases
sirolimus
blood concentrations
Dose
oropharyngeal candidiasis
-oral suspension: 100 mg , PO BID on Day 1, then
100
mg PO qDay for 13 days
-Refractory to itraconazole and/or fluconazole: 400
m
Newly approved formulation of
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Newly approved formulation ofPosaconazole
1-FDA has approved a new formulation of posaconazole
(Noxafil,
Merck), The agency approved posaconazole 100-mg delayed-
release
tablets, given as a loading dose of 300 mg (three 100-mg
delayed-
release tablets) twice daily on the first day, followed by a once-
daily
maintenance dose of 300 mg (three 100-mg delayed-release
tablets)
on the second day of therapy. Merck also markets posaconazole
(also
Newly approved formulation of
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Newly approved formulation of
Posaconazole
2-FDA has approved an intravenous (IV) formulation of the
posaconazole (Noxafil, Merck), according to the company.
Posaconazole injection is indicated in patient at least 18 years
of age, whereas the delayed-release tablets and oralsuspension are
indicated in patients aged 13 years and older. Posaconazole is
indicated for prophylaxis of invasiveAspergillusand Candida
infections in patient who are at high risk of developing these
infections because of being severely immunocompromised,
such as
hematopoietic stem cell transplant recipients with graft-vs-host
6 Cl t i l (C ti )
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6-Clotrimazole (Canestin)
IndicationFor fungal skin infection, vaginal candidiasis and otitis
externa
Dose
1-vaginal cream:
a- 1 %: insert 1 applicatorfulvaginal cream at bedtime
for 7 consecutive daysb- 2 %: insert 1 applicatorfulvaginal cream at bedtime
for 3 consecutive days
2-topical cream and solution: apply to affected area twice
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7-Econazole (Pevaryl)
Indicationtinea pedis, Tinea cruris, Tinea corporis, Tinea
versicolor and cutaneous candidiasis
Dose1-Tinea pedis, cruris, corporis, versicolor: apply cream
to
affected area qDay
2-Cutaneous candidiasis:apply cream to affected area,BID
Treatment duration
Tinea cruris, corporis, versicolor, cutaneous candidiasis:
for 2
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8-Miconazole ( Dactarin )
- Used for:
Tinea-1
a-Tinea cruris, corporis & cutaneous
canidiasis: apply to affected area BID for 2 weeks
b-Tinea versicolor: apply once daily to affectedarea
for 2 weeks
c-Tinea pedis: apply BID to affected area for 4weeks
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8-Miconazole ( Dactarin )
2-Vulvovaginal candidiasis
a-Vaginal 2% cream : once daily , before sleep
for 7days.
b-100 mg vaginal suppository once daily , before
sleep for 7days .
c- 200 mg vaginal suppository once daily , before
sleep for 3 day
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Polyene Antifungals
Polyene Antifungal
It binds to sterols in fungal cell membrane,
leading to alterations in cell permeability and
celldeath
1-Amphoter ic in B
- It is most effective antifungal agents in thetreatment of systemic fungal infection,especially in immunocompromised patients
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Type Advantage Disadvantage
Conventional cheap Toxic and side effectscommon
Lipid formulation Less toxic and side effects
Given when conventional
thearapy contraindicated
because of toxicity especially
nephrotoxicity or when
respone inadequate
Expensive
- Types
1-Amphotericin B
1 A h i i B
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1-Amphotericin B
Precaution
1-infusion-related reaction: fever, chills, vomiting,
nausea, headache, hypotension, dyspnea,tachypnea (need test dose before start Infusion)
" A test dose is advisable before the firstinfusion, the patient should be observed for at
least 30 min after the test dose "Premedication with acetaminophen,
diphenhydramine,hydrocortisone should be usedfor patient who have previously experienced acute
adverse reaction
1 A h t i i B
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1-Amphotericin B
2- Nephrotoxicity: need dose adjustmentor drug D/C or change to liposomal form
3-electrolyte abnormalities :Hypokalemia, hypomagnesemia, and
hypocalcemia
4-CNS effects: headache, peripheralneuropathy,
malaise, depression, seizure, hallucination
2 N t ti ( M t t)
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2-Nystatin( Mycostat)
2-nystatinIndication and Dose
1-Cutaneous or mucocutaneous Candidainfections:
apply 2-3 times daily for 2 weeks
2-vaginal infections: I tab daily at bedtime for 2weeks
3- GI candidal infection:
a- oropharngeal candidiasis :
Oral suspension: 400,000-600,000 units PO q6hr;
N t ti
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Nystatin
b-Intestinal candidiasis
-Oral tablets: 500,000-1,000,000 units q8hr
-Powder: 1/8 to 1/4 teaspoonful in 1/2 cup of water
(500,000-1,000,000 units) PO q8hr
Fl t i
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Flucytosine
Flucytocin
M.O.A
It penetrates fungal cells and converted tofluorouracil, then incorporated to the RNA offungal cell. This action leads to defect proteinsynthesis
Indications-Used alone not recommended
-It is used with amphotericin B in synergistic
combination for treatment of severe systemic
fungal
Fl t i
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Flucytosine
Dose-Candidiasis & Cryptococcus infection : 50-150
mg/kg/dose, orally, q6hr
CautionBone marrow depression can occurs
Black Box Warnings
Use extreme caution in patients with renalimpairment
Monitor hematologic, renal, and hepatic function
Review instructions thoroughly beforeadministration
G i f l i
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Griseofulvin
GriseofulfinM.O.A
-It inhibits fungal cell activity by interfering withmitotic
spindle structure
- it deposit in keratin precursor cells and is tightly
bound to new keratin, and this increases resistance
to
fungal invasion
-It is mechanism of action similar to colchicines it
G i f l i
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Griseofulvin
IndicationTreatment of susceptible tinea infections of
skin,body,hair and nails
Dosea- Microsize (orally)
1-Tinea corporis, cruris, or capitis: 500 mg/day
2-Tinea pedis: 1000 mg/day
b-Ultramicrosize (orally)
1-Tinea corporis, cruris, or capitis: 375 mg/day
2-Tinea pedis : 250 mg, q8hr
G i f l i
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Griseofulvin
Duration of treatment Dependent oninfection site
1-Tinea corporis: 2-4 weeks
2-Tinea capitis: 4-6 weeks; may be up to 8-12weeks
3-Tinea pedis: 4-8 weeks
"Absorption increased with fatty meals"
G i f l i
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Griseofulvin
Most common Side effects
- Headache, lethargy, syncope, confusion,
lethargy,
impaired performance, and skin rash
Severe skin reactions (eg, Stevens-Johnson
syndrome,
toxic epidermal necrolysis) and erythema
multiforme
reported, some resulting in hospitalization or
death;
G i f l i
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Griseofulvin
Drugs interaction
1-it increases the metabolism of warfarin and
lead to decrease prothrombin time
2-Oral contraceptive may increase amenorrhea
or increase breakthrough bleeding
E hi di
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Echinocandins
Echinocandins1-caspofungin
2-micafungin
3-anidulafungin
-They cause cell wall lysis
-have activity againt candida spp and aspergillus
species
-available as Injection dosage form
S nthetic all lamine
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Synthetic allylamine
M.O.AInhibits squalene monooxygenase and this lead to
interruption of fungal sterol biosynthesis
1-Terbinafine ( Lamisil )
Oral sys tem ic p reparation
Indication and dose1-Onychomycosis
250 mg (1 tablet) PO daily for 6 weeks (fingernail)or
12 weeks (toenail)
Terbinafine ( Lamisil )
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Terbinafine ( Lamisil )
2- Tinea pedis ( off-label use ) 250 mg/day PO for2- 6 weeks
3- Tinea corporis and tinea crusis 250 mg/day PO
for 2-4 weeks
Common side effects
1-headache
2-taste disturbances
3-visual disturbances
4-skin rash
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Terbinafine ( Lamisil )
Top ical preparat ion
Indication and dose
1- Tinea PedisApply to affected area BID until significant
clinical improvement (no more than 4 weeks)
2-Tinea corporis and crurisApply daily for 1 week (no more than 4 weeks)
Terbinafine cutaneous solution
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Terbinafine cutaneoussolution
( Lamisil once)
Indication
It is a single dose treatment for tinea pedis
Side effect
burning, dryness, pruritis, rash, irritation
Terbinafine cutaneoussolution
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( Lamisil once)
- How to use: apply to both feet, even ifsigns
are visible only on one foot. When applied
to
the feet, the medication dries quickly to a
colourless film. The drug delivers into the
skin
where it lasts for a number of days to kill the
fungus .after applying the drug, patient must
Naftifine ( Exodril)
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Naftifine ( Exodril)
2-Naftifine ( Exodril)
Indication & Dose
1- 1% cream treatment
-Used for treatmen of tinea pedis, tinea cruris,and tinea corporis
-apply BID to the affected areas plus a 0.5-inch
margin of healthy surrounding skin for 4 weeks
Naftifine ( Exodril)
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Naftifine ( Exodril)
2- 2% cream or gel
-Used for treatment of interdigital tinea pedis,
tinea cruris, and tinea corporis
-Apply daily to the affected areas plus a 0.5-inchmargin of healthy surrounding skin for 2 weeks
CautionAvoid use of occlusive dressings
Amorolfine ( Loceryl)
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Amorolfine ( Loceryl)
Amorolfine
IndicationTopical treatment of nail infections caused by fungi
(onychomycosis)
DoseApply to affected toenails or fingernails once or twice
weekly
Duration
- - -
Ciclopirox ( Mycoster)
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Ciclopirox ( Mycoster)
CiclopiroxM.O.A
Synthetic benzylamine
It inhibits intermediary in synthesis of ergosterol, an
essential component of fungal cell membranes
Indication and dose
1-Mild to moderate onychomycosis of fingernails &toenails:
1- topical solution: apply over entire nail plate dailybefore sleep or 8 hours before washing to all affectednails
Ciclopirox ( Mycoster)
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Ciclopirox ( Mycoster)
2-Tinea pedis, Tinea corporis, Tinea cruris, Tineavesicolor, and cutaneous candidiasis :
Cream and suspension: apply BID; gentlymassage into affected areas; if noimprovement after 4 weeks re-evaluatediagnosis
3-Seborrheic dermatitis:
-Gel: Apply BID; gently massage into affectedareas; if no improvement after 4 weeks re-evaluate diagnosis
Tolnaftate
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Tolnaftate
Tolnaftate
M.O.A
distort the hyphae and stunt mycelial growth in
susceptible fungiIndication & Dose
Superficial fungal infection
apply BID for 2-3 weeks
Clioquinol
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Clioquinol
Clioquinol
It is used for fungal skin infection : apply two tofour times a day up to 4 weeks
Newly approved drugs:
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Newly approved drugs:
1-Luliconazole ( Luzu)
- FDA has approved the azole antifungal
luliconazole
1% cream to treat fungal infections
- Luliconazole 1% cream is indicated for the
topical
treatment of interdigital tinea pedis (athlete's foot),tinea cruris and tinea corporis , in adults aged 18
years
and older.
1-Luliconazole ( Luzu)
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1-Luliconazole ( Luzu)
It is the first topical azole antifungal agent
approved to treat tinea cruris and tinea corporis
with a 1-week, once-daily treatment regimen. All
other currently approved treatments require 2weeks of treatment. For interdigital tinea pedis,
the treatment period is 2 weeks, once daily
2 Efinaconazole
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2- Efinaconazole
Efinaconazole
- It is used for the topical treatment of
onychomycosis.
- Efinaconazole is an inhibitor of sterol 14-
demethylase and is more effective in vitro than
terbinafine, itraconazole, ciclopirox and amorolfine
against dermatophytes, yeasts and non-
dermatophyte
molds.
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similar to the oral antifungal itraconazole andexceeds
the efficacy of topical ciclopirox
- efinaconazole 10% nail solution is an effectivetopical monotherapy for distal and lateral
subungual onychomycosis (
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feeding
Breast feedingPregnancy categoryDrugEnters breast milkCKetoconazole
use caution as topical,
vaginal not known
CMiconazole
Not recommendedCFluconazole
Enter breast milk so
weigh risk against
benefits
CItraconazole
not known if excreted in
breast milk, weighrisk/benefit
DVoriconazole
unknown; weigh
risk/benefit
CPosaconazole
Pregnancy category and
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breast feeding
Breast feedingPregnancyDruguse with cautionBClotrimazole
-Conventional:
contraindicated
-liposomal: not
recommended
BAmphotericin B
1-systemicNot known if
excreted in breast milk; use
caution
2-Topical: no studies
3-vaginal: Poorly
distributed in breast milk
1-systemic: c
2-topical: B
3-vaginal:A
Nystatin
not recommendedcFlucytocin
Avoid useXGriseofulvin
Avoid useBterbinafine
Pregnancy category and
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breast feeding
Breast feedingPregnancyDrugavoid unless
potential benefit
outweigh risk
avoid unless
potential benefit
outweigh risk
Amorolfin
not known ifdistributed in breast
milk
BCiclopirox
Use cautionBNaftifine
UnknownCTolnaftate