Itraconazole superficial infections

Systemic drugs for superficial infections Griseofulvin Terbinafine, ketoconazole, fluconazole, itraconazole... 

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. 

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. 

Haria M, Bryson HM, Goa KL. Itraconazole. A reappraisal of its pharmacological properties and therapeutic use in the management of superficial fungal infections. Drugs 1996 51(4) 585-620. Erratum in Drugs. 1996 52(2) 253. 

A study in 24 patients with superficial dermatophyte, Candida albicans and pityriasis versicolor infections, given itraconazole 50 or 100 mg daily, found that taking the drug with or after breakfast produced higher serum levels and gave much better treatment results than taking it before breakfast. A later study found that the relative bioavailability of itraconazole was 54% on an empty stomach, 86% after a light meal and 100% after a full meal. Similar results were found in other studies. - ... 

Some of imidazoles and triazoles are the potential inhibitors of 14-demethylase, a key enzyme in the sterol biosynthesis pathway, thus directly interfere with cell wall biosynthesis in Leishmania. Fluconazole, a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections, has been used for the treatment of L. major in Old World. Similarly, ketoconazole has been used in the New World against L. panamensis and L. mexicana. Itraconazole... 

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