Dr. Perez Flashcards
Vulvovaginal Candidiasis (VVC) most common pathogens
- Candida albicans
- Candida glabrata (more likely to be resistant)
VVC risk factors
- Pregnancy
- Diabetes
- Immunocompromised
- Abx use
- intravaginal contraception
- High dose oral contraceptive agents
Signs and symptoms of VVC
- Itching
- Pain/soreness
- Cheese like discharge
Definition of uncomplicated VVC
- Mild to moderate s/sxs
- Less than 3 episodes per year
- Immunocompetent
- Not pregnant
- Female
Treatment of uncomplicated VVC
-Topical azole antifungal
Topical azole product counseling
- Can decrease efficacy of latex condoms
- Don’t use tampons concomitantly
- Administer at night time
- Wear a pad to help decrease messes
Definition of complicated VVC
- Immunocompromised
- Uncontrolled diabetes
- Pregnant patients
Recurrent VVC
-4 or more events in 12 months
Treatment of complicated VVC
-Azole antifungal
Antifungal resistant VVC
- Persistently positive yeast cultures and failure to respond to antifungal therapy despite adherence
- Usually Candida glabrata
Treatment of Candida glabrata/ resistant VVC
- Boric acid vaginal suppositories x 14days
- Fluconazole 150mg x 1 dose
- Most common in pts with diabetes
Non-pharm recommendations for VVC
- Avoid harsh soaps
- Keep ya junk clean and dry
- Avoid tight clothing
- Cool baths to sooth skin
Treatment of Uncomplicated VVC
- Topical Azole for 3 to 7 days depending of formulation
- Fluconazole oral x 1 dose
Treatment of Complicated VVC
-Oral fluconazole 150mg Q72hrs for 2 to 3 doses
or
-Topical azole for 7 to 14 days
+/- low potency topical corticosteroid for 48hrs
Treatment of VVC in pregnancy
-Topical clotrimazole
or
-Topical miconazole
-for 7 days
Recurrent VVC treatment
-Induction with
1) Fluconazole 150mg q72hr x 3 doses
or
2) Topical azole for 7-14 days
-Maintenance
1) Fluconazole 150mg qweekly x 6 months
Oropharyngeal (OPC) and Esophageal Candidasis (EPC)
- Most common pathogen is Candida albicans
- Opportunistic infection in HIV/AIDS
Risk factors for OPC/EPC
- Steroid or abx use
- Dentures
- Dry mouth
- Neonates/elderly
- Immunocompromised
- Diabetes
- Nutritional deficiencies
Treatment of mild to moderate OPC
- 7 to 14 days of therapy
- Clotrimazole 5x daily
- Miconazole 1 tab daily
- Nystatin swish and swallow 4x daily
Treatment for moderate to severe OPC
- 7 to 14 days of therapy
- Fluconazole 100 to 200mg daily
Treatment of fluconazole refactory OPC
- 14 to 28 days of therapy
- Itraconazole
- Posaconazole
- Voriconazole
Treatment of EPC
- 14 to 21 days of therapy
- Fluconazole (PO/IV)
- Echinocandin (IV)
Treatment of fluconazole Refractory EPC
- 14 to 21 days of therapy
- Itraconazole (PO)
- Posaconazole (PO)
- Voriconazole (PO)
- IV echinocandin if needed
Treatment of recurrent EPC, chronic suppressive therapy
-Fluconazole 100 to 200mg 3x/week chronically!
Common pathogens in Dermatophyte infections
- Trichophyton
- Microsporum
- Epidermophyton
- Malassezia (tinea versicolor)
Tinea Corporis (Ring worm)
- Most common in children
- Trunk, extremities, face
- Treatment with topical antifunal
- Don’t share towels or clothes
Tinea Cruris (jock itch)
- More common in males
- Thighs and buttocks
- Treatment with topical antifungal ( 1 to 2 weeks of therapy)
- Keep area dry, check for tinea pedis too
Tinea Vesicolor
- Hyper/hypopigmentation
- Scalp, face, trunk
- Topical antifungal
- Sunlight will help the skin return to its normal color
Tinea Pedis (athletes foot)
- Scaly feet/toes
- Topical antifungal
- Disinfect footware, control excessive sweating, wear nonocclusive shoes
Tinea Unguium (Onychomycosis)
- Yellowish/brownish nail discoloration
- More common in adults (Diabetes or trauma)
- Terbinafine is 1st line (systemic is better than topical in this case)
- 4 to 6 months for finger nail to grow back
- 12 to 18 months for big toe nail to grow back
Clinical Pearls for Terbinafine
- Don’t give in patients with hepatic disease
- Monitor LFTs, prior to initiation and monthly there after
- Moderate CYP2D6 inhibitor
Treatment of Onychomycosis
-Terbinafine 250mg/day for 6 weeks (fingernail) 12 weeks (toenail)
