ANTIFUNGAL TREATMENT

ATC J02AC01 J02AX Use antifungal (treatment of vaginal, oropharyngeal and atrophic oral candidiasis)... 

The approach to antifungal therapy in patients with endemic fungal infections is determined by the severity of clinical presentation, the patient s underlying immunosuppression, and potential toxicities and drug interactions associated with antifungal treatment. 

Does the patient require antifungal treatment at this time ... 

In comparison to antimicrobial therapy, antifungal treatment is limited to a very small number of drug substances. 

Erythematous (Atrophic) Candidiasis. No pseudomembranes the mucosal surface is inflamed, often associated with local discomfort. In its chronic variant, bacteria probably play a pathogenic role too, so the use of antiseptics in addition to antifungal treatment is essential. 

The reason for antifungal treatment and the concurrent use of other medication may contribute to hepatotoxicity (SED-12, 675) (1,6). 

Hiddemann W, Essink ME, Fegeler W, Zuhlsdorf M, Sauerland C, Buchner T. Antifungal treatment by amphotericin B and 5-fluorocytosine delays the recovery of normal hematopoietic cells after intensive cytostatic therapy for acute myeloid leukemia. Cancer 1991 68(1) 9-14. 

Bronkometer isoetharine. bronopol [ban, bsi,inn,jan is an antibacterial and antiseptic, and a plant antifungal treatment. It is used as a preservative in cosmetics and toiletries, broparestrol [inn] (BDPE LN 107) is a synthetic nonsteroid OESTROGEN and analogue of stilboestrol used therapeutically in ANTICANCER therapy and in dermatology, broquinaldol [inn] is a methylquinoline ANTIFUNGAL and ANTIBACTERIAL. 

Antifungal treatments have become increasingly important as fungal infections have become one of the top five most frequently encountered in the clinic. This increase is associated with the... 

A man with epilepsy, well controlled with phenytoin, developed symptoms of phenytoin toxicity within one day of starting intravenous miconazole 500 mg every 8 hours and flucytosine. After one week of eoneurrent treatment his serum phenytoin levels had risen by 50%, from 29 to 43 mierograms/mL. He had some symptoms of very mild phenytoin tox-ieity before the antifungal treatment was started. Another patient develop symptoms of toxicity (nystagmus, ataxia) within 5 days of starting to take oral miconazole 500 mg daily. His serum phenytoin level rose to 40.8 micrograms/mL. After discontinuation of the miconazole the same dose of phenytoin resulted in a level of 14.5 micrograms/mL. ... 

Fluconazole-refractory oropharyngeal candidiasis is a common condition in human immunode-ciency virus (HIV) -positive patients. Twelve such patients were treated with 15 mL of a M. alterni-folia oral solution (Breath-Away) four times daily for 2 weeks, in a single center, open-label clinical trial. The solution was swished in the mouth for 30-60 s and then expelled, with no rinsing for at least 30 min. Clinical assessment was carried out on days 7 and 14, and also on days 28 and 42 of the follow-up. Two patients were clinically cured and six were improved after the therapy however, four remained unchanged and one deteriorated. The overall clinical response rate was thus 67% and was considered as a possible alternative antifungal treatment in such cases (Jandourek et al., 1998). 

Fig. 27.8. Neutropenic febrile patient who underwent autologous stem-cell transplantation due to non-Hodgkin lymphoma. At day 2 after transplantation, neutropenia and fever occurred. Therefore, antifungal treatment (Amphotericin B) was started. Ill-defined pulmonary nodules were diagnosed at day 7. Haematological reconstitution took place at day 13, si-...

The first observations to suggest that some quaternary ammonium compounds, such as benzalkonium chloride, stearalkonium chloride, and cetylpyridine chloride, have antimicrobial activity were made in as early as 1916, but their full potential was first realized in the 1930s [1, 2 J. Since then their uses have steadily increased and include many industrial purposes, water treatment, and antifungal treatment in horticulture, as well as inclusion in pharmaceutical and everyday consumer products. For example, benzalkonium chloride, the most commonly used, is found in products such as eye drops, artificial tears, decongestion nose drops, facial moistures, facial cleansers, acne treatments, sun protection creams and lotions, body lotions, moisturizers, pain relievers, and hand sanitizers [3 ]. Very often good reasons for their use are lacking and claims are limited to assertions that they are bug-killers . 

Kolmer HL, Taketomi EA, Hazen KC, Hughs E, Wilson BB, Platts-MiUs TA. Effect of combined antibacterial and antifungal treatment in severe atopic dermatitis. J Allergy Clin Immunol 1996 98(3) 702-707. 

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