Fungal Infection

Question 1

What are the different fungal infections and how do you treat it

Answer 1

Aspergillosis
- treated with voriconazole

Cryptococcosis
- amphotericin B

Thrush
- vaginal- cltrimazole/ fluconazole: if resistant then itraconazole
Oral: nystatin/ miconazole/ fluconazole- if resistant then itraconazole

Skin and nail infections
Topical therapy- systemic therapy (itraconazole and terbinafine)

Question 2

What is the main skin fungal infections

Answer 2

Tinea which is ringworm
Tinea capitis- head
Tinea corporis- body
Tinea cruise- groin
Tinea pedis- feet
Tine unguium/ onychomycosis- nails

Treat with topical antifungal cream or terbinafine

Nail region terbinafine or amorilfine nail lacquer
- once weekly for up to a year
- refre to go if under 18, more than 2 nails affected, diabetic, pregnant or breastfeeding

Question 3

What are the side effects of antifungals

Answer 3

Fluconazole, itraconazole, ketoconazole + voriconazole
- QT prolongation and hepatotoxicity
— less risk in fluconazole, more risk in ketoconazole, voriconazole and itraconazole

Itraconazole
- carbonated drinks improves itraconazole bioavailability

Ketoconazole
- life threatening hepatotoxicity- oral treatment suspended (CHMP advice)

Voriconazole
-phototoxicity occurs uncommonly- avoid sunlight exposure

Question 4

What other side effects can antifungals have

Answer 4

Amphotericin B
- caution in renal failure
-anaphylaxis risk in IV amphotericin B- test dose within 30 minutes observation
— prophylactic antipyretics or hydrocortisone in patients with previous reactions
- maintain same formulation between conventional,liposomal and lipid complex formulations- serious haram and fatal overdose have occurred

Terbinafine
Hepatotoxic