53 - Antifungal Agents

Question 1

Case study 1

A 55-year old obese woman with adult-onset diabetes mellitus has been receiving amoxicillin for treatment of acute exacerbation of chronic bronchitis. After 1-week of therapy, the patient develops dysuria and increased urinary frequency. Urinalysis shows 25 WBCs per hpf, and a Gram-stain of the urine shows budding yeast. Which treatment is most appropriate for her Candida cystis?

A. oral ketoconazole
B. oral fluconazole
C. topical clotrimazole
D. oral itraconazole
E. oral 5-flucytosine

Answer 1

B. oral fluconazole

well absorbed, drug of choice for invasive candidiasis

Question 2

Why are the other options NOT recommended?

Answer 2

A. oral ketoconazole
poorly absorbed, high toxicity relative to other azoles.

C. topical clotrimazole
topical not appropriate for cystitis

D. oral itraconazole
poorly absorbed

E. oral 5-flucytosine
high toxicity, don’t need to use a bazooka to treat a UTI.

Question 3

Case study 2

A 34-year old male presents with fever (103.5 F), cough, dyspnea, and bloody sputum. The patient is currently completing his second round of chemotherapy for non-Hodgkin lymphoma. A CXR reveals diffuse alveolar infiltrates on the right lobe and small cavitary lesions on the left lobe. Bronchoalveolar lavage reveals septate hyphae, branching at ~45O angel (V-shaped). Which of the following drugs would be most appropriate fro treating this patient?

A. flucytosine
B. terbinafine
C. griseofulvin
D. nystatin
E. voriconazole

Answer 3

E. voriconazole

treatment of choice for invasive aspergillosis

Question 4

Why are the other options NOT recommended?

Answer 4

A. flucytosine
effective against
Cryptococcus

B. terbinafine
only used in treating skin and nail infections

C. griseofulvin
only used in treating skin infections

D. nystatin
toxic, only used topically