FUNGAL DISEASE👉
Antifungal Drugs
STEP 2: Indications of Antifungal DrugsAmphotericin B Is useful agent for nearly all life-threatening mycotic infections.It is often used as the initial induction regimen for serious fungal infections and is then replaced by one of the newer fluconazole Is s especially important for immunosuppressed patients and those with severe fungal pneumonia, cryptococcal meningitis with altered mental status, or sepsis syndrome due to fungal infections.
Clotrimazole, Miconazole and Fluconazole Are useful agents in management of candida species, Cryptococcus neoformans, the endemic mycoses (blastomycosis, coccidioidomycosis and histoplasmosis) .
Griseofulvin is only use is in the systemic treatment of dermatophytosis example infections of the skin, scalp, hair and nails where topical therapy has failed or is inappropriate.
Nystatin used in treatment of oral candidiasis; and skin infection.
STEP 3: Contraindications of Antifungal Drugs
Amphotericin B is not contraindicated to specific group of individual.
Clotrimazole, Miconazole and Fluconazole are contraindicated in acute porphyria, hepatic impairment and breast-feeding.
Griseofulvin is contraindicated to people with severe liver disease; systemic lupus erythematosus acute, porphyria, pregnancy (avoid pregnancy during and for 1 month after treatment men should not father children within 6 months of treatment) and breast-feeding.
Nystatin is not contraindicated to specific group of individual.
STEP 4: Dose, Dosage and Course of Systemic and Mucosal Antifungal Drugs
Amphotericin B lozenges taken 4 times daily. Allowed to dissolve slowly in the mouth for 10 to 15 days (continued for 48 hours after lesions have resolved); increased to 8 daily in severe infection.
Clotrimazole 2% cream for vaginal candidiasis. Applied twice a day for 7 days.
Miconazole Topical: 2% cream, is used for vaginal candidiasis, vulvovaginal candidiasis and candidal balanitis, 200 mg vaginal suppositories is used for vaginal candidiasis .The drug is applied twice daily for 5 to 7 days
.Fluconazole Vaginal candidiasis, Vulvovaginal Candidiasis, and candidal balanitis, ADULT and children over 16 years, by mouth, a single dose of 150 mg. Mucosal candidiasis (except genital), by mouth, 50 mg daily (100 mg daily in unusually difficult infections) given for 7 to 14 days in oropharyngeal candidiasis.
Griseofulvin Dermatophyte infections, 500 mg once daily or in divided doses. In severe infection dose may be doubled, the dose need to be reduced when response occurs children under 50 kg, 10 mg/kg once daily or in divided doses Tinea capitis caused by Trichophyton tonsurans, 1g once daily or in divided doses children under 50 kg, 15 20 mg/kg once daily or in divided doses.Treatment should continue for not less than 21 days.
Nystatin Treatment for adult and children suffering from oral pharyngeal candidiasis 100 000 units 4 times daily after food, usually for 7 days (continued for 48 hours after lesions have resolved).
STEP 5: Side Effects and Adverse Effects of Antifungal Drugs
Amphotericin B
When given parenterally it causes anorexia, nausea and vomiting, diarrhoea, epigastric pain, febrile reactions, headache, muscle and joint pain, anaemia disturbances in renal function and renal toxicity.
Clotrimazole
The most common adverse reaction is relatively minor gastrointestinal upset and, very rarely, clinical hepatitis.
Miconazole.
Causes nausea, vomiting; rash; with buccal tablets Abdominal pain, taste disturbance, burning sensation at application site, pruritus, and oedema; with oral gel, very rarely diarrhoea (usually on long term treatment), hepatitis, toxic epidermal necrolysis, and Stevens-Johnson syndrome.
Fluconazole.
Causes nausea, abdominal discomfort, diarrhea, flatulence, headache and rash.
Griseofulvin.
Causes nausea, vomiting, diarrhea and headache Less frequently hepatotoxicity, dizziness, confusion, fatigue and sleep disturbances occurs.
Nystatin oral irritation, sensitization and nausea.
STEP 6: Interactions and Precautions of Antifungal Drugs:
Amphotericin B Increase neurotoxicity of aminoglycoside.Increase cellular toxicity of flucytosine.There is an increased risk of hypokalemia when used with loop diuretics Increases cardiac toxicity of digoxin.
Clotrimazole has no important interaction.
Miconazole has no important interaction.
Fluconazole has no important interaction.
Griseofulvin Enhance effect of alcohol, Reduces effect of anti coagulants.Its absorption is reduced by phenobarbitone.Accelerate metabolism of oral contraceptives.
Nystatin has no important interaction
STEP 7: Key points:
Amphotericin and fluconazole are important for immunosuppressed patients and those with severe fungal pneumonia, cryptococcal meningitis with altered mental status, or sepsis syndrome due to fungal infections.
Systemic and oral Antifungal Drugs are usually used in candidiasis.
Amphotericin is contraindicated in liver diseases.Amphotericin should not be given with oral contraceptives. Miconazole may cause Stephen Johnson syndrome.
Fluconazole is contraindicated in acute porphyria and hepatic impairment List interactions of griseofulvin Griseofulvin requires longer duration of treatment up to 12 months in nail infection
STEP 8:References
Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael. 2014. Pharmacotherapy: a pathophysiologic approach (9th ed.). New York,. McGraw-Hill Education.
Ministry Of Health and Social Welfare. 2013.Standard Treatment Guidelines & Sally S.R, Jeanne C.S. 2000.
Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins School of Pharmaceutical sciences. 2011.
Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press.
The Royal Pharmaceutical Society of Great Britain. 2007.
Martindale, the Extra Pharmacopoeia (5TH ed). London, pharmaceutical press.
The Royal Pharmaceutical Society of Great Britain. 2009.
British National Formulary (59th ed). London, BMJ Group and RPS Publishing.
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