Antifungal agents for common outpatient paediatric infections

Question 1

What is the incidence of oropharyngeal candidiasis?

Answer 1

5-10%

Question 2

What are the recommended therapies for oropharyngeal candidiasis?

Answer 2

1. First line: Nystatin 200 000U QID x 7-14d, curing 50% in 1 week and 80% in 2 weeks
2. Second line: Second generation imidazole (fluconazole or itraconazole) maybe considered if conventional therapy fails or in immunocompromised
3. Gentian violet moderately effective but stains
4. First generation imidazoles (miconazole and clotrimazole) not recommended

Question 3

What are the recommended therapies for candida diaper dermatitis?

Answer 3

1. Eliminating impervious diaper covers
2. Changing diapers frequently
3. Leaving diapers off for long periods of time
4. Topical antifungal: miconazole, nystating, and clotrimazole
5. no clear evidence whether oral antifungals should be used
6. no clear evidence whether concurrent low concentration steroids should be used

Question 4

What organism causes pityriasis or tinea versicolor?

Answer 4

Malassezia

Question 5

What is pityriasis versicolor?

Answer 5

Mild or chronic condition characterized by scaly hypo-or hyperpigmented lesions on the trunk. Often occurs in teens when the sebaceous glands are active

Question 6

What is the treatment for pityriasis versicolor?

Answer 6

Topical ketoconazole, selenium sulfide or clotrmiazole to the affected area 15-30min nightly for 1-2 weeks, then once a month for 3m to avoid recurrence

Question 7

What organism causes tinea corporis?

Answer 7

Trichophyton rubrum
Trichophyton metagrophytes
Microsporum species esp. Microsporum canis and Epidermophyton floccosum

Question 8

What is tinea corporis?

Answer 8

A superficial circular infection of the skin that is not covered by hair?

Question 9

What is the treatment for tinea corporis?

Answer 9

Topical clotrimazole, ketoconazole, miconazole or terbinafine applied once or twice daily x 14-21d. Avoid corticosteroids.

Question 10

What organisms cause tinea pedis?

Answer 10

T rubrum
T metagrophytes
E floccosum

Question 11

What is tinea pedis?

Answer 11

Athlete’s foot a common superficial fungal infection of the foot

Question 12

What is the treatment for tinea pedis?

Answer 12

Topical antifungals i.e. fluconazole, itraconazole, terbinafine
Drying agents i.e. Burow’s solution
Good foot hygiene
Oral antifungals if infection involves the toenails

Question 13

What organism causes tinea capitis?

Answer 13

M canis in Europe

Trichophyton tonsurans in N. America

Question 14

What is tinea capitis?

Answer 14

A fungal infection of the scalp

Question 15

What is the treatment?

Answer 15

Oral antifungal therapy in conjunction with topical therapy

Question 16

What organism causes seborrheic dermatitis and pityriasis capitis (cradle cap)?

Answer 16

Malassezia species (e.g. Malassezia furfur)

Question 17

What is seborrheic dermatitis and pityriasis capitis?

Answer 17

Cradle cap

Question 18

What is the treatment for seborrheic dermatitis and pityriasis capitis?

Answer 18

Mild soap application

Shampoos containing selenium sulfide or an azole

Question 19

What is fluconazole?

Answer 19

Triazole with activity against candida, some dermatophytes and many systemic mycoses. Its hydrophilic and not useful for routine treatment of most superficial infections.

Question 20

What is itraconazole?

Answer 20

An azole with activity against many dermatophytes, Candida species, M furfur, and some moulds. It has a long half life in skin and nails and reaches it via lipids and keratin and maybe excreted in sebum for 1m after therapy is d/c. Good first line agent for tinea capitis.

Question 21

What is ketoconazole?

Answer 21

Azole which can treat resistant superficial fungal infections such as tinea capitis

Question 22

What is terbinafine?

Answer 22

Lipophilic and keratinophilic fungicidal agent active against dermatophytes and some moulds. It is well tolerated and treats tinea unguium, tinea pedis, tinea corporis, tinea cruris, and tinea capitis.

Question 23

What are the drug interactions for azoles?

Answer 23

Metabolism by hepatic cytochrome P450 3A and may inhibit the elimination of other drugs metabolized by this enzyme such as antiarrhythmics, cortisol, cyclosporin, estradiol, and tacrolimus.

Question 24

What topical antifungals are available in Canada?

Answer 24

1. Clotrimaderm
2. Gentian violet
3. Ketoconazole
4. Miconazole
5. Nystatin
6. Terbinafine
7. Tolnaftute
8. Selenium sulfide

Question 25

What oral antifungals are available in Canada?

Answer 25

1. Ketoconazole
2. Fluconazole
3. Itraconazole
4. Terbinafine