Fungal infections, drugs used topical

The most widespread are dermatophytic fungal infections, which include skin, hair, and nails. Most infections can be cured by using topical drugs, such as tolnaftate, undecylenic acid, haloprogin, clotrimazole, and miconazole. Griseofulvin is used orally for deep infections, in particular for infections of the nail bed. Currently, ketoconazole is widely used for treating chronic dermatophytes. 

The pharmacologic treatment of parasitic infections is a complex and extensive topic. In this limited space, it is difficult to describe the many species of each parasite, all the diseases caused by parasites, and the chemical methods currently available to selectively destroy various fungi, protozoa, and helminths in humans. Consequently, the general aspects of each type of parasitic infection are reviewed briefly, followed by the primary drugs used to treat specific fungal, protozoal, and helminthic infections. This discussion will acquaint physical therapists and occupational ther-... 

Agents used to treat common fungal infections are listed in Tables 35-1 and 35-2. As indicated in Table 35-1, certain drugs can be administered systemic ally to treat infections in various tissues. Other agents are more toxic their use is limited to local or topical application for fungal infections in the skin and mucous membranes (Table 35-2). The use of systemic and topical antifungal agents is addressed in more detail below. 

Fungal infections superficial dermatophyte or Candida infections purely involving the skin can be treated with a topical imidazole (e.g. clotrimazole, miconazole). Pityriasis versicolor, a yeast infection, primarily involves the trunk m young adults it responds poorly to imidazoles but topical terbinafine or selenium sulphide preparations are effective severe infection may require systemic itraconazole. Invasion of hair or nails by a dermatophyte or a deep mycosis requires systemic therapy terbinafine is the most effective drug. Terbinafine and griseo-fulvin are ineffective against yeasts, for which itraconazole is an alternative. Itraconazole can be used in weekly pulses each month for 3-4 months it is less effective against dermatophytes than terbinafine. 

Dichlorophen is an antihelminthic drug that was used in the treatment of tapeworm infections but has been superseded by praziquantel and niclosamide. It also has antifungal and antibacterial activity and has been used topically in the treatment of fungal infections and as a germicide in soaps and cosmetics (1). 

The use of the polyenes for the treatment of systemic infections is limited by the toxicities of the drugs, their low water solubilities, and their poor chemical stabilities. Amphotericin B. the only polyene useful for the treatment of. serious systemic infections, must be solubilized with a detergent. The other polyenes are indicated only as topical agents for superficial fungal infections. 

Some of these drugs (for example ketoconazole and fluconazole) are used orally to treat systemic fungal infections others (for example econazole and tioconazole) are used topically to treat skin and nail infection. 

Topical administration to the epidermis of the skin is generally used for drugs intended to have a local effect. This route is of particular relevance to podiatrists and can be used to treat a local infection or other conditions. For example, the use of amorolfine cream in the treatment of fungal skin infections. 

Our results indicate that topical fluconazole instillation may be useful to treat fungal and Acanthamoeba infections of the anterior ocular segment because it ensures sufficiently high ocular penetration of the drug without noticeable local toxicity. 

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