topical agents are active only against...
inhibit fungal cell mitosis at metaphase.
MoA of butenafine.
- inhibit ergosterol by blocking squalene
MoA of Lamisil.
- inhibit ergosterol synth by blocking squalene.
MoA of clotrimazole (Lotrimin)
- bind to phospholipid in cell memb altering permeability.
- thus losing intracell elements.
MoA of Micatin (miconazole)
- bind to phospholipid on cell membrane so alters permeability.
- thus losing intracell elements.
bind to phospholipid on cell membrane so alters permeability. thus losing intracell elements.
blocks fungal CYP450 so alters permeability to cell wall.
inhibit transfer of essential elements in fungal cell wall and disrupts synth of DNA, RNA and protein.
A) undecylenic acid (Cruex)
distorts hyphae adn stunts mycelial growth.
B) tolnaftate (Tinactin)
tinea pedis: scaling in btwn toes.
C) chronic intertriginous
tinea pedis: both feet mocassin like scalring ont he soles of the feet.
C) chronic papulosquamous
tinea pedis: vesicles or pustules by the instep and plantar.
tinea pedis: macerated weeping ulceration on the sole.
A) acute ulcerative
if superficial infxn of athelete's foot, how long do you treat with topical?
what to do if athlete's foot with cracks or breaks in the skin or nail involvement?
need oral therapy!
how is the recurrent rate with athlete's foot?
about 70% so prolonged therapy is needed.
Lotrimin Ultra generic?
Lamisil generic and availability?
Lotrimin AF generic?
Micatin AF generic?
Nizoral A-D generic?
what are the oral agents for athelete's foot and when do you use them?
- fluconzole 150mg once wkly x 1-4 wk
- ketoconazole 200mg daily x 4 wk
- itraconazole 200-400 mg daily x 1 wk
- terbinafine 250mg daily x 2wk
- use when cracks or breaks in the skin or nail is involved.
how to treat tinea cruris?
- treat with topical tx for 1-2 wk after resolution of sympts.
- severe infxn needs oral therapy.
what topical agents to use for tinea cruris?
- lotrimin ultra 1% daily x 2 wk
- lamisil AT 1% daily-bid x 1-4 wk (cr); daily x 1 wk (gel)
- micantin jock itch 2% bid x 4 wk
- nizoral a-d 1% daily x 2 wk
oral therapy for tinea cruris?
- lamisil 250mg qd x 2wk
- nizoral 250mg qd x 4 wk
- diflucan 150mg wkly x 2-4 wk
- griseofulvin 500mg q24h x 4-8 wk
tinea capitis: gray scaling on the hair shaft.
tinea capitis: pustules with exudate
tinea capitis: hair braeks off and leaves a black dot on scalp.
C) black dot
tinea capitis: pathcy areas of hair loss and yellowish crusts and scales. (scutula)
oral agents used for tinea capitis?
- Lamisil 250mg daily 4-8 wk
- Sporanox 3-5mg/kg/d x 30 d
- Diflucan 8mg/kg/d x 8-12wk
- griseofulvin 500mg daily 4-6 wk
is topical tx successful for tinea unguinum?
oral agents used for tinea unguinum fingernail vs. toenail duration.
- lamisil 250mg qd: 6 wk vs. 12wk
- sporanox 200mg daily: 6 wk vs. 12 wk
- itraconazole 200mg bid x 1 wk/mo: 2 mo vs. 3-4 mo
- diflucan 150-300mg wkly: >6mo vs. >12mo
7 exclusions for self treatment for tinea infection?
- causative factor unclearunsuccessful initial tx or worsening
- nails, scalp, genitalia involved
- signs of secondary bacterial infxn (oozing, purulent material)
- excessive and continuous exudation, extensive, serious inflamm, debilitating
- DM, asthma, immune deficiency, systemic infxn
- fever, malaise
common cause of vulvovaginal candidiasis?
what disease states would put VVC as complicated?
- uncontrolled DM
- immunosupp (HIV)
if non-albican, VVC would be...
typical symptoms of VVC
pruritis, vaginal discharge, soreness, burning, extrenal dysuria
you have yeast cx (+) without symptoms. do you have VVC?
- cx without sympt is NOT indication for therapy b/c yeast is a normal flora in vagina
- do cx to see if yeast and non-albican (complicated) are present
how long do you treat uncomplicated VVC?
1-3 days short course or single dose topical
for uncomplicated VVC, what is more effective?
azole vs. nystatin
when do you recomm self med with OTC for uncompl VVC?
when previously dx who present with same sympts
when to seek med care wtih uncompl vvc?
when sympt persist or recur within 2 mo
what regimen to use for uncompl VVC?
- intravaginal agents: butoconazole, clotrimazole, miconazole, terconazole, nystatin
- oral: fluconazole
clinical presentation of severe VVC
extensive vulvar erythema, edema, excoriation, fissure formation
can you do short course tx for severe VVC?
no, poor result
how to treat severe VVC?
- topical azole x 7-14 days
- fluconazole 150mg po x 2 doses (3 days apart; 72h)
what defines recurrent VVC?
equal to or > 4 sympt outbreaks within 1 year
what should you do if you suspect recurrent vvc?
- do cx to confirm causative pathogen
- c. glabrata etc.
how to treat recurrent vvc?
- longer duration:
- topical for 7-14 d
- fluconazole 100mg, 150mg or 200mg q 3rd day x 3 doses
- fluconazole 100mg, 150mg, or 200mg po q wk x 6 mo
- clotrimazole 200mg top twice wkly
- clotrimazole 500mg supp weekly
what candida would it be if patient has exposure to azole antifungal and still has candida?
topical treatment for oropharyngeal candidiasis
- clotrimazole troche 10mg 4-5 daily x 7-14 days
- nystatin 100,000 units 5 ml QID x 7-14 days
- nystatin 200,000 units troche QID x 7-14 days
drug of choice systemic treatment for oropharyngeal candidiasis
- LD 200mg
- MD 100mg/day
when you have severe oro candidiasis or worried about non-albican spp, what do you use?
what to use for refractory oropharyngeal candidiasis?
- posaconazole 400mg bid x 7 days
- itraconazole 100mg bid
what is systemic treatment for esophageal candidiasis?
- LD 200mg
- MD 100mg daily (up to 400mg daily)
- (same as oropharyngeal)
- itra, vori, posa
what do you give for esopharyngeal candidiasis if the pt cannot swallow?
- IV fluconazole
- caspofungin 50mg daily
- mycafungin 150mg daily
- anidulafungin LD 100mg, MD 50mg