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Antifungal Therapy Cheat Sheet by

pharmacology

Fungal Infections

"­Opp­ort­unistic Infect­ion­s":
Candid­iasis:
- Wide spread use of broad spectrum of Antibi­otics
- Elderly
- HIV patients
- Diabetic patients
- Immuno­sup­pre­ssants and cancer chemot­herapy patients
- Pregnant women
 
- Burn wound victims

Fungal Infection Treatments

Superf­icial Fungal Infect­ions:

Dermat­omy­coses: skin, hair, nails (onych­omy­coses)
- Candid­iasis
- Tinea versicolor
- Dermat­oph­ytoses

Dermat­oph­ytoses:

- Trich­oph­yton, Micros­porum, Epider­mop­hyton
- Tinea capitis
- Tinea cruris
- Tinea pedis
- Tinea corporis (Tre­atm­ent: Clotri­mazole 2% cream, apply tds for 2 weeks after lesion has cleared)
Clinical Featur­es:
- Itchy ring-like patches
- Raised borders
- Patches slowly grow bigger = as patches extend, a clear area develops in the center which may become hyperp­igm­ented in dark skin.

Tinea Versic­olor:

- also implicated for dandruff/ seborr­hoeic dermat­ittis
- Selenium sulphide (Selsun)
- Zinc pyrithoine (Head and Shoulders)
- Soap: Sulphur (10%) and Salicylic acid (3%)
 

Oral Candid­iasis (Thrush):

- Presents: painful creamy white patches, can be scraped off tongue and buccal mucosa.
- Common in healthy babies (up to 1mo)
- Risk Factors: Poor Oral Hygiene, Immuno­sup­pre­ssion, Prolonged use of broad spectrum antibi­otics or cortic­ost­eroids (including inhaled), Certain chronic diseases, Trauma
- General Measur­es: Identify underlying cause, Improve oral hygiene, Ensure proper fitting dentures
Trea­tme­nt:
- Nystatin suspen­sion, oral, 100 000 IU/mL, 1ml, 6 hourly after each meal/feed for 7 days.
= Keep in contact with affected area for as long as possible prior to swallowing
= In older children, ask child to swirl in mouth prior to swallowing
= In infants: apply to front of mouth and spread around mouth with clean finger
= continue for 48hrs after cure

Tinea Capitis:

Round or patchy bald areas with scales and stumps of broken of hair
Avoid shaving head in children
Don't share combs and hair brushes = Contagious
Trea­tme­nt:
- Children: Flucon­azole, oral, 6mg/kg once daily for 28 days
- Adults: Flucon­azole, oral, 200mg once daily for 28 days

Systemic (Disse­min­ated) Fungal Infect­ions:

- Crypto­coccal meningitis
- Candid­iasis
- Pulmonary asperg­illosis
- Histop­las­mosis

Candida Oesoph­agitis:

- Oesoph­ageal involement in HIV infected patients with oral candid­iasis who have pain or difficulty swallowing
- Maintain hydration
- Flucon­azole 200,g po daily for 14 days
- Refer: unable to swallow, poor response to flucon­azole
 

Antifu­ngal: Mechanisms of Action

Classes of Antifungal Treatment

Amphot­eracin B:

- Drug of Choice of severe systemic mycoses
- pks: admini­stered IV, eliminated slowly in urine
- !!neph­rot­oxi­city, hypoka­lemia
- High probab­ility of AEs: drugs tox and admini­str­ation
- NB: toxicity monitoring (dosage and duration NB)

Nystatin

- GI absorption is negligible
- Most of dose excreted in stool
- safe in pregnancy
- MOA: same as amphot­eracin B

Flucon­azole:

Treatment for: Candid­iasis, CCM (maint­enance txt)
Pks: D-wide, CFS; Unchanged in urine (DA)
- WEAK INHIBITOR of P450

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