Imidazoles dermatophyte infections

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remains useful in the treatment of cutaneous and mucous membrane dermatophyte and yeast infections, but it has been replaced by the newer triazoles in the treatment of most serious Candida infections and disseminated mycoses.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. 

Indications Candidiasis, dermatophyte infections of the skin Category Antibiotic, imidazole Half-life N/A... 

The azole derivatives for systemic administration include the imidazoles ketoconazole and miconazole and the triazoles fluconazole, itraconazole, posaconazole and voriconazole. They are broad spectrum antifungals and have activity against several dermatophytes, Candida, Cryptococcus and other fungi that cause deep-seated infections. 

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. 

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. 

Oxiconazole, Sulconazole, and Sertaconazole are imidazole derivatives used for the topical treatment of infections cansed by the common pathogenic dermatophytes. Oxiconazole nitrate (Oxistat) is available as a cream and... 

When introduced in the early 1980s, ketoconazole (Fig. 24.4) was seen as a useful clinical development as it represented the first imidazole antifungal that had sufficient oral bioavailability to make it useful in the treatment of cutaneous (dermatophytic) and systemic (mycotic) yeasts, with weaker activity against a limited number of moulds (e.g. Aspergillus spp.) infections. 

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