Dermatophytes treatment

At the tested daily dose of 50 mg, fluconazole appears to be slightly less active against dermatophytes. The substance is used mainly to treat vaginal candidosis (a single capsule of 150 mg) and oral and esophageal candidosis (50 mg od for 14 d). In a number of countries, ie, England, the maximal period of treatment is 14 d. 

Future Antimycotics for Systemic Treatment. Two new antimycotics for systemic use have now reached the stage of clinical development. The first is a triazole and fluoride analogue of itraconazole. This compound (saperconazole) is extremely active 2i 2cm.%. Jisperpillus spp. and slightly more soluble. Consequentiy, intravenous adruinistration might be possible (34). The second molecule is terbinafine [91161 -71 -6] an aHylamine, C21H25N, that appears to be particularly active against dermatophytes, just like topical naftifine (35). 

Due to the divergence of fungal diseases, there is neither single best treatment nor a superior drug for all diseases. However, a superior drug does exist for dermatomycoses caused by dermatophytes, namely the allylamine terbinafine (TER). For the treatment of deep mycoses in immunosuppressed patients the most efficacious drug is the polyene Amph B. 

Treatment of severe recalcitrant cutaneous dermatophyte infections not responding to topical therapy or oral griseofulvin or in patients unable to take griseofulvin. 

Minimum treatment of recalcitrant dermatophyte infections is 4 weeks in cases involving glabrous skin. Palmar and plantar infections may respond more slowly. 

Onychomycosis (capsules only) Treatment of onychomycosis of the toenail with or without fingernail involvement and onychomycosis of the fingernail because of dermatophytes Tinea unguium) in nonimmunocompromised patients. Oropharyngeal/esophageal candidiasis (oral solution only) Treatment of oropharyngeal or esophageal candidiasis. 

Topical formulations of nystatin and of amphotericin B are useful in the management of Candida albicans infections of the skin. Both antibiotics are ineffective against dermatophytes. The use of nystatin is limited to topical treatment of cutaneous and mucosal Candida infections because of its narrow spectrum and its negligible absorption from the gastrointestinal tract. Hypersensitivity reactions are rare. It is not known whether topical nystatin can cause fetal harm when used by a pregnant woman. Amphotericin B has broader antifungal activity but its topical use is restricted to Candida. Topical use of amphotericin B has shown minimal absorption through the skin and is well tolerated. Limited human surveillance data do not indicate any harm to mother or fetus, but relative safety is still unknown. 

Terbinatine is closely related to naftiflne and has similar activity. It is used for the topical treatment of dermatophyte infections. It can give local irritation and erythema and care should be taken to avoid contact with eyes and mucous membranes. 

Itraconazole (Sporanox), a triazole, is highly lipophilic and concentrates in skin. It is approved for both cutaneous deep fungal infections and dermatophyte nail disease, for which shorter courses of therapy are probably effective. Pulse therapy, whereby the drug is administered for 1 week and then the patient is off treatment for 3 weeks between pulses, may reduce toxicity without compromising antifungal efficacy. 

Despite negligible cerebrospinal fluid concentrations, itraconazole shows promise in the treatment of cryptococcal and coccidioidal meningitis. Additional uses for itraconazole include treatment of vaginal candidiasis, tinea versicolor, dermatophyte infections, and onychomycosis. Fungal naU infections account for most use of this drug in the outpatient setting. 

Ketoconazole remains useful in the treatment of cutaneous and mucous membrane dermatophyte and yeast infections, but it has been replaced by the newer triazoles in the treatment of most serious Candida infections and disseminated mycoses. Ketoconazole is usually effective in the treatment of thrush, but fluconazole is superior to ketoconazole for refractory thrush. Widespread dermatophyte infections on skin surfaces can be treated easily with oral ketoconazole when the use of topical antifungal agents would be impractical. Treatment of vulvovaginal candidiasis with topical imidazoles is less expensive. 

Miconazole (Monistat) is a broad-spectrum imidazole antifungal agent used in the topical treatment of cutaneous dermatophyte infections and mucous membrane Candida infections, such as vaginitis. Minimal absorption occurs from skin or mucous membrane surfaces. Local irritation to skin and mucous membranes can occur with topical use headaches, urticaria, and abdominal cramping have been reported with treatment for vagiiutis. 

Clotrimazole (Lotrimin, Gyne-Lotrimin, Mycelex) is a broad-spectrum fungistatic imidazole drug used in the topical treatment of oral, skin, and vaginal infections with C. albicans. It is also employed in the treatment of infections with cutaneous dermatophytes. 

Naftifine hydrochloride (Naftin) is available for topical use only in the treatment of cutaneous dermatophyte and Candida infections it is as effective as topical azoles for these conditions. 

In the treatment of ringworm of the beard, scalp, and other skin surfaces, 4 to 6 weeks of therapy is often required. Therapy failure may be to the result of an incorrect diagnosis superficial candidiasis, which may resemble a dermatophyte infection, does not respond to griseofulvin treatment. Onychomycosis responds very slowly to griseofulvin (1 year or more of treatment is commonly required) and cure rates are poor itraconazole and terbinafine hydrochloride are more effective than griseofulvin for onychomycosis. 

Ciclopirox olamine (Loprox) is a pyridone derivative available for the treatment of cutaneous dermatophyte infections, cutaneous C. albicans infections, and tinea versicolor caused by Malassezia furfur. It interferes with fungal growth by inhibiting macromolecule synthesis. 

Tolnaftate (Tinactin, others) is a nonprescription antifungal agent effective in the topical treatment of dermatophyte infections and tinea. The mechaitism of action is unknown. 

Other older, less effective topical antifungal agents still available include undecyleitic acid Desenex, others). Used in the treatment of topical dermatophytes, undecyleitic acid is fungistatic, requires prolonged administration, and is associated with a high relapse rate. Desenex, containing 5% undecyleitic acid and 20% zinc undecylenate, is effective in the prevention of recurrent tinea pedis. 

The spectrum of action of azole medications is broad, including many Candida species, C neofbrmans, the endemic mycoses (blastomycosis, coccidioidomycosis, histoplasmosis), the dermatophytes, and, in the case of itraconazole and voriconazole, even aspergillus infections. They are also useful in the treatment of intrinsically amphotericin-resistant organisms such as P boydii. 

The two azoles most commonly used topically are clotrimazole and miconazole several others are available (see Preparations Available). Both are available over-the-counter and are often used for vulvovaginal candidiasis. Oral clotrimazole troches are available for treatment of oral thrush and are a pleasant-tasting alternative to nystatin. In cream form, both agents are useful for dermatophytic infections, including tinea corporis, tinea pedis, and tinea cruris. Absorption is negligible, and adverse effects are rare. 

The treatment of superficial fungal infections caused by dermatophytic fungi may be accomplished (1) with topical... 

Fluconazole is well absorbed following oral administration, with a plasma half-life of 30 hours. In view of this long half-life, daily doses of 100 mg are sufficient to treat mucocutaneous candidiasis alternate-day doses are sufficient for dermatophyte infections. The plasma half-life of itraconazole is similar to that of fluconazole, and detectable therapeutic concentrations remain in the stratum corneum for up to 28 days following termination of therapy. Itraconazole is effective for the treatment of onychomycosis in a dosage of 200 mg daily taken with food to ensure maximum absorption for 3 consecutive months. Recent reports of heart failure in patients receiving itraconazole for onychomycosis have resulted in recommendations that it not be given for treatment of onychomycosis in patients with ventricular dysfunction. 

Griseofulvin is a fungistatic antibiotic with no antibacterial activity. It is highly effective against dermatophytes and has therefore been used orally for treatment of ringworm in a variety of animals. For calves and horses, it is mainly used as a feed additive at dosages of 10-30 mg/kg bw/day for 7-35 days. 

Terbinafine (Lamisil) is an allylamine with activity similar to that of naftifine hydrochloride. It is available as a 1% cream and solution for the topical treatment of dermatophyte infections. 

Antifungal spectrum The drug is principally fungistatic. It is effective only against the dermatophytes—Trichophyton. Microsporum. and Epidermophyton. It is used in the treatment of severe tinea infections that do not respond to other antifungal agents. 

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