Fungal infections treatment

Table 15 gives a sampling of other pharmaceuticals derived from hydraziae. Cefazolin, a thiadiazole tetrazole derivative, is one of the most widely used antibacterial dmgs in U.S. hospitals (see Antibiotics, P-LACTAMs). Procarbazine, an antineoplastic, is a monomethyUiydrazine derivative (220). Fluconazole has shown some promise in the treatment of AIDS-related fungal infections. Carbidopa is employed in the treatment of Parkinson s disease. FurazoHdone is a veterinarian antibacterial. 

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Fluconazole (4) (s the first member of a new generation of orally acti ve antifungal agents, highly effective in the treatment of dermal and vaginal infections [6, 7] S-Fluorocyrtosine (5) is also used to treat serious systemic fungal infections [5]... 

Three fungal infections - Madura feet (mycetoma), chromomycosis and sporotrichosis - fall into the category of subcutaneous mycoses, their distribution is mainly in tropical and subtropical areas. The ideal treatment for madura feet caused by fungi is not yet established the azoles are of some benefit, however, neither the optimal drug, dose, nor the treatment schedules are known. Chromomycosis responds well to ITRA monotherapy or the combination of 5FC plus ITRA. ITRA has been set up as standard therapy for cutaneous and lymphatic sporotrichosis. 

Amphotericin B is the most effective drug available for die treatment of most systemic fungal infections. Administration often results in serious reactions,... 

Promoting an Optimal Response to Therapy Superficial and deep fungal infections respond slowly to antifungal therapy. Many patients experience anxiety and depression over the fact that therapy must continue for a prolonged time Depending on the method of treatment, patients may be faced with many problems during therapy and therefore need time to talk about problems as they arise Examples of problems are the cost of treatment, hospitalization (when required), the failure of treatment to adequately control the infection, and loss of income. The nurse must help the patient and the family to understand that therapy must be continued until tlie infection is under control. In some cases, therapy may take weeks or months. 

P. (1985). Liposomal amphotericin B for the treatment of systemic fungal infections in patients with cancer A preliminary study, J. Infect. Pis., 151, 704-710. 

Lopez-Berestein, G. (1989). Treatment of systemic fungal infections with liposomal-amphotericin B, in Liposomes in the Therapy of Infectious Diseases and Cancer (G. Lopez-Berestein and I. J. Fidler, eds.), Alan R. Liss, New York, pp. 317-327. 

Wiebe, V. J., and Degregorio, M. W. (1988). Liposome-encapsulated amphotericin B A promising new treatment for disseminated fungal infections. Rev. Infect. Pis., 10. 1097-1101. 

Diaper rashes lasting longer than 48 to 72 hours are at increased risk for the development of fungal infections. These complications are most frequently caused by Candida albicans and require treatment with a topical antifungal35,36 (Fig. 62-6). 

Immunocompetent patients generally do not require reassessment after treatment. Patients with neutropenia exhibit an increased risk of dissemination of infection, and therefore should be monitored for signs of systemic fungal infection. Due to an increased risk of recurrence, HIV-positive patients should routinely be evaluated for recurrence at each visit. 

Recommend appropriate empiric or targeted antifungal therapy for the treatment of invasive fungal infections. 

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. 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

The CSFs should not be used routinely for treatment of febrile neutropenia in conjunction with antimicrobial therapy.5 However, the use of CSFs in certain high-risk patients with hypotension, documented fungal infection, pneumonia, or sepsis is reasonable. A recent meta-analysis demonstrated that hospitalization and neutrophil recovery are shortened and that infection-related mortality is marginally improved.14 As with prophylactic use of these agents, cost considerations limit their use to high-risk patients. 

Miconazole is an imidazole antifungal agent used as miconazole base or miconazole nitrate for the treatment of superficial candidiasis and of skin infections dermato-phytosis and pityriasis versicolor. The drug has also been given intravenously by infusion for the treatment of disseminated fungal infections. Miconazole can be given by mouth in a dose of 120-240 mg, as oral gel four times daily after food, for... 

Posaconazole, launched last year in the UK, is the newest member of the azole class of antifungal agents to reach the market. It is indicated for the treatment and prophylaxis of a range of invasive fungal infections, including aspergillosis,... 

---