Flashcards in Antifungal agents for common outpatient paediatric infections Deck (25):
What is the incidence of oropharyngeal candidiasis?
What are the recommended therapies for oropharyngeal candidiasis?
1. First line: Nystatin 200 000U QID x 7-14d, curing 50% in 1 week and 80% in 2 weeks
2. Second line: Second generation imidazole (fluconazole or itraconazole) maybe considered if conventional therapy fails or in immunocompromised
3. Gentian violet moderately effective but stains
4. First generation imidazoles (miconazole and clotrimazole) not recommended
What are the recommended therapies for candida diaper dermatitis?
1. Eliminating impervious diaper covers
2. Changing diapers frequently
3. Leaving diapers off for long periods of time
4. Topical antifungal: miconazole, nystating, and clotrimazole
4. no clear evidence whether oral antifungals should be used
5. no clear evidence whether concurrent low concentration steroids should be used
What organism causes pityriasis or tinea versicolor?
What is pityriasis versicolor?
Mild or chronic condition characterized by scaly hypo-or hyperpigmented lesions on the trunk. Often occurs in teens when the sebaceous glands are active
What is the treatment for pityriasis versicolor?
Topical ketoconazole, selenium sulfide or clotrmiazole to the affected area 15-30min nightly for 1-2 weeks, then once a month for 3m to avoid recurrence
What organism causes tinea corporis?
Microsporum species esp. Microsporum canis and Epidermophyton floccosum
What is tinea corporis?
A superficial circular infection of the skin that is not covered by hair?
What is the treatment for tinea corporis?
Topical clotrimazole, ketoconazole, miconazole or terbinafine applied once or twice daily x 14-21d. Avoid corticosteroids.
What organisms cause tinea pedis?
What is tinea pedis?
Athlete's foot a common superficial fungal infection of the foot
What is the treatment for tinea pedis?
Topical antifungals i.e. fluconazole, itraconazole, terbinafine
Drying agents i.e. Burow's solution
Good foot hygiene
Oral antifungals if infection involves the toenails
What organism causes tinea capitis?
M canis in Europe
Trichophyton tonsurans in N. America
What is tinea capitis?
A fungal infection of the scalp
What is the treatment?
Oral antifungal therapy in conjunction with topical therapy
What organism causes seborrheic dermatitis and pityriasis capitis (cradle cap)?
Malassezia species (e.g. Malassezia furfur)
What is seborrheic dermatitis and pityriasis capitis?
What is the treatment for seborrheic dermatitis and pityriasis capitis?
Mild soap application
Shampoos containing selenium sulfide or an azole
What is fluconazole?
Triazole with activity against candida, some dermatophytes and many systemic mycoses. Its hydrophilic and not useful for routine treatment of most superficial infections.
What is itraconazole?
An azole with activity against many dermatophytes, Candida species, M furfur, and some moulds. It has a long half life in skin and nails and reaches it via lipids and keratin and maybe excreted in sebum for 1m after therapy is d/c. Good first line agent for tinea capitis.
What is ketoconazole?
Azole which can treat resistant superficial fungal infections such as tinea capitis
What is terbinafine?
Lipophilic and keratinophilic fungicidal agent active against dermatophytes and some moulds. It is well tolerated and treats tinea unguium, tinea pedis, tinea corporis, tinea cruris, and tinea capitis.
What are the drug interactions for azoles?
Metabolism by hepatic cytochrome P450 3A and may inhibit the elimination of other drugs metabolized by this enzyme such as antiarrhythmics, cortisol, cyclosporin, estradiol, and tacrolimus.
What topical antifungals are available in Canada?
2. Gentian violet
8. Selenium sulfide