Anti-fungal agents: Therapy for specific diseases

on 16.3.06 with 0 comments

Mild skin infections

Mainly use a topical preparation including some of the following

  • Azoles
  • Allylamines

Or over the counter stuff

  • Tolnaftate (Tinactin)
  • Clotrimazole
  • Miconazole
  • Terbinafine (Lamisil)

Severe skin infections

  • Oral antifungal agents, mainly itraconazole

Tinea Capitis (ringworm of the scalp)

  • Oral therapy with Griseofulvin
  • Could also use azoles if Griseofulvin fails

Onychomycosis (infection of the nails)

  • Griseofulvin for 6-12 months
  • Or itraconazole and terbinafine for 3 months
  • Topical preparations like Ciclopirox are easy to use, but have a low cure rate

Tinea Versicolor (sun spots)

  • Topical ketoconazole for small spots
  • For larger areas, use oral itraconazole or fluconazole for a short time

Chromomycosis (infections of the skin and sub-cutaneous)

  • Surgical excision when possible
  • In conjunction with itraconazole for 12-36 months
  • When surgery is not possible, Amphotericin B may be necessary

Mycetoma (a tumor caused by filamentous bacteria or filamentous fungi)

  • Surgical excision, maybe even amputation
  • In combination with an Azole for 1 to 3 years

Zygomycosis (mucormycosis, phycomycosis) (opportunistic infections)

  • Quickly initiate therapy with Amphotericin B
  • (Azoles are not effective against mucormycosis)
  • In diabetic patients, control the acidosis, then surgically debride the tissue


Allergic bronchopulmonary aspergillosis

  • Desensitization protocols
  • Along with oral corticosteroids


  • Surgically excise
  • Along with oral itraconazole
  • Or IV amphotericin B

Invasive aspergillosis

  • Amphotericin B, but the outlook is still poor


Superficial candidiasis

  • Creams or ointments containing an Azole or Nystatin

Oropharyngeal candidiasis

  • Nystatin swish and swallow
  • Or an Azole troche formulation

Esophageal candidiasis

  • Treat with an oral Azole
  • In AIDS pt’s, use Fluconazole, b/c the absorbtion of itraconazole and ketoconazole depends on gastric acid secretion, which may be depressed (achlorohydric) in a pt with AIDS

Vaginal Candidiasis

  • One dose of 150mg of Fluconazole
  • Or two doses of 200mg itraconazole given 8 hours apart
  • Also vaginal creams and suppositories

Systemic Candidiasis

  • Amphotericin B
  • Removal of the artificial heart valve or indwelling catheter, if that is the cause

Cryptococcosis (CNS and disseminated infection)

  • Treat with a combination of Amphotericin B and 5-fluorocytosine
  • This combination allows for synergism and a reduction in the dose of Amp B

Blastomycosis (cutaneous, pulmonary and disseminated)

  • For mild cases, treat with Itraconazole for at least 6 months
  • For severe cases, treat with Amphotericin B for several weeks

Histoplasmosis (a disease of the reticuloendothelial system RES)

  • Pulmonary, disseminated or ocular
  • For mild cases, treat with Itraconazole
  • For severe cases, treat with Amphotericin B

Coccidioidomycosis (cutaneous, pulmonary, ocular, disseminated, and Valley Fever)

  • Amphotericin B for life-threatening infections
  • Itraconazole or fluconazole for milder cases
  • Itraconazole is primarily used, but Fluconazole has better BBB penetration, so
  • Extended therapy with Fluconazole is indicated with CNS involvement
  • Could require lifetime administration

Paracoccidioidomycosis (South American Blastomycosis)

  • Mucocutaneous, pulmonary, lymphatic, and visceral
  • Treat with Itraconazole for many months

Sporotrichosis (cutaneous and visceral)

  • Cutaneous sporotrichosis, use Itraconazole
  • Lymphatic sporotrichosis, use Itraconazole
  • For systemic infection, treat with Amphotericin B

Unusual Opportunistic Organisims

  • Rule of thumb, treat with Amphotericin B

Category: Pharmacology Notes



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