60. Antifungals

Question 1

Mycosis

Answer 1

Superficial
   > Dermatophytes (ring worm): 
            -Trictophytons, microsporum
   > Yeasts: Malessezia, canidia, aspergillus
  Systemic: Aspergillus, blastomyces

Question 2

Local anti-fungals

Answer 2

1. Poliene antibiotics (cidal):
   
   • Natamycin
   • Nystatin
2. Azoles (cidals): use in combination
   > Imidazoles
   - Thiabendazole (malassezia)
   - Enilconazole
   - Miconazole
   - Ketoconazole (systemic use)
   > Triazole
3. Allylamines (cidal)
   
   • naftifine
   • Terbinafine (local + systemic)
4. Others
   
   • Tolnaflate (For athletes foot)
   • Chlorohexidine
   • Hexachlorophen
   • Benzoic acid
   • Salcyclic acid
   • Dyes

Question 3

Systemic anti-fungals

Answer 3

Antibiotics
   > Griseofluvin (static): dermatophytes
       -Ihibit microtuble formation
   > Amphotericin- B (poliene AB)
        ***Nephrotoxic-only for life threatening infections***
Azoles: 
    > Ketoconazole (local and systemic)
       - cats sensitive (hepatotoxic)
       - MAlessezia
       - 3 week duration
   > Itraconazole
       -less toxic
   > Fluconazole
       -better abs, safer
3. Allylamines
    > Terbinafine (local + systemic)
       - Dermatophytes
4. lufenuron
5. Flucytosine
       -Mainly yeasts
       - Severe cryptococcosis