superficial fungal infection Flashcards
what is the main pathogen responsible for vulvovaginal candidiasis ( yeast infection)?
1st- candida albicans**
2nd- candida glabrata (due to resistant VVC there gas been a shift)
what are the risk factors for VVC?
initial sexual activity
oral-genital contact
contraceptive agent
antibiotic use
DM -sglt2
immunosuppression
pregnancy
clinical presentation of VVC?
symptoms: intense inching, soreness, irritation, burning on urination, painful intercourse
signs: erythema, fissure, clumpy, thick, white cottage cheese like discharge with no foul odor, edema
normal pH (4-4.5)
culture only if reccurrent
non pharm treatment for VVC?
keep area dry and clean
avoid harsh or perfumed soaps and douching
avoid tight and constrictive clothing
discontinue any precipitating medications ( steroids)
when is self treatment recommended for uncomplicated VVC?
for women with multiple confirmed prior cases who report the same symptoms
Are there any difference in the cure rates between oral and topical azole for VVC?
no
what is the treatment day range for nonprescription patients in uncomplicated VVC?
1-7 days
pregnancy = 7 days
what dosage form is recommended for pregnant women and how many days if they have uncomplicated VCC?
topical 7days
avoid oral
uncomplicated VVC OTC products
Butoconazole
clotrimazole
miconazole (caution with warfarin)
tioconazole (ointment)
uncomplicated VVC prescription
nystatin 1 tab x 14d
terconazole
fluconazole 150mg 1 tabs x 1day (repeat in 3days if recurrent)
uncomplicated VCC number of tablets
one
complicated VCC treatment
oral fluconazole 150mg every 72hrs x 2-3 doses
what patients are included in complicated VVC
immunocompromised
uncontrolled DM
pregnancy
what is the duration of treatment for uncontrolled DM and immunocompromised (complicated )
10-14 days
what topical VVC should pregnant women receive ?
topical imidazole for 7days
can’t take fluconazole
bee honey and yogurt may beneficial as adjunct therapy
for pregnancy if VCC worsens and exceeds 7 days
IV amp B
recurrent VVC
having >= 3 episodes < 12 months
10- 14 days oral or topical followed by fluconazole 150 mg weekly x 6 months
antifungal resistent VVC infection
generally c. glabrata
boric acid 600 intravaginally daily x 14 days, followed by one capsule twice weekly
toxic if taken orally
new VCC treatment for acute VCC
ibrexafungerp (brexafemmeO
MOA: triterpenoid fungal that inhibits glucan synthase
SE: diarrhea, nausea, abdominal pain
CI pregnancy, strong CYP3A4 inhibitors
new VVC treatment for for reducing the incidence or recurrent VCC
oteseconazole (vivjoa)
MOA: antifunal that inhibits 14a demethylase
SE: Nausea, HA
CI: pregnancy and lactation
what is the most common pathogen in oropharyngeal and esophageal candidiasis (thrush)
c. albicans
risk factors of oropharyngeal and esophageal candidiasis
medications (corticosteroids, cytotoxic agents, PPI, antibiotics)
environmental changes
poor dental hygiene
xerostomia
smoking
immunosupressant therapy
young infants , elderly
HIV/AIDS
DM
thyroid, parathyroid, adrenal dysfunction
cancer and radiation therapy
nutritional deficiencies
treatment for mild for oropharyngeal candidiasis
clotrimazole troche 10 mg
-hold in the mouth for 15-20 mins until dissolve
miconazole mucoadhesive buccal tab 50 mg daily x 7-14days
nystatin suspenpension 1000 units/ml
- for dryer mouth
- nausea
- high in sugar (does not help DM pts)
-not preferred in HIV pts
treatment for moderate to severe oropharyngeal candidiasis
fluconazole tablet 100-200 mg daily 7-14 days
itraconazole 10 mg/ml solution x up to 28 days
general duration of therapy 7-14 days
refactory treatment for severe oropharyngeal candidiasis
IV enchinocandins
IV amphotericin B
not highly rec