fungal infections Flashcards
candidiasis (pseudomembranous and erythematous) - predisposing factors
inhaled corticosteroids, cytotoxic or broad-spectrum antibacterials
diabetics
nutritional deficiencies
serious systemic disease associated with reduced immunity e.g. leukaemia, other malignancies, HIV
candidiasis (pseudomembranous and erythematous) - when should you refer to specialist/GP?
if pt doesn’t respond to appropriate local measures and a course of drug tx
no identifiable cause
immunocompromised pt with serious systemic disease - likely to need IV systemic tx
candidiasis (pseudomembranous and erythematous) - first tx approach
local measures
candidiasis (pseudomembranous and erythematous) - local measures
advise pts who use a CS inhaler to rinse their mouth with water or brush their teeth immediately after using the inhaler
candidiasis (pseudomembranous and erythematous) - first line drug tx options
fluconazole capsules 50mg
miconazole oromucosal gel 20mg/g
candidiasis (pseudomembranous and erythematous) - fluconazole
capsules 50mg
7 capsules x1 daily
can administer for max 14 days for tx of oropharyngeal candidosis
candidiasis (pseudomembranous and erythematous) - fluconazole contraindications
warfarin
statins
candidiasis (pseudomembranous and erythematous) - miconazole
oromucosal gel (can get SF) 20mg/g 80g tube, apply a pea sized amount after food x4 daily continue use for 7 days after lesions have healed
candidiasis (pseudomembranous and erythematous) - miconazole contraindications
warfarin
statins
candidiasis (pseudomembranous and erythematous) - if miconazole and fluconazole contraindicated?
nystatin oral suspension 100000 units/ml
candidiasis (pseudomembranous and erythematous) - nystatin
oral suspension 100000 units/ml
30ml
1ml after food x4 daily for 7 days
advise pt to rinse suspension around mouth and then retain suspension near lesion for 5mins before swallowing
advise pt to continue use for 48hrs after lesions have healed
denture stomatitis - first line tx
local measures
denture stomatitis - local measures
brush palate daily to tx
clean dentures thoroughly (soak in CHX MW or NaOCl for 15mins x2 daily (NaOCl is only for acrylic))
leave dentures out as often as possible during tx period
CHX MW effective
if dentures are identified as contributing to problem - adjust/make new dentures to avoid recurrence
denture stomatitis - what can anti fungal agents be used as?
an adjunct
esp to reduce palatal inflammation before taking impressions for new dentures
denture stomatitis - first line antifungals
fluconazole capsules
miconazole oromucosal gel
denture stomatitis - fluconazole
50mg capsules
7 capsules, x1 daily
max 14 days
denture stomatitis - fluconazole contraindications
warfarin
statins
denture stomatitis - miconazole
oromucosal gel (can get SF) 20mg/g
80g tube
apply a pea sized amount to fitting surface of upper denture after food x4 daily
advise pt to remove U denture, apply gel sparingly to fitting surface and then reinsert
advise pt to continue use for 7days after lesions have healed
denture stomatitis - miconazole contraindications
warfarin
statins
denture stomatitis - drug tx if fluconazole and miconazole contraindicated
nystatin oral suspension 100000units/ml
denture stomatitis - nystatin
oral suspension 100000 units/ml
send 30ml
1ml after food x4 daily for 7 days
advise pt to remove dentures before using drug, rinse suspension around mouth and then retain suspension near lesion for 5mins before swallowing
advise pt to continue use for 48hrs after lesions have healed
angular cheilitis - usual cause if dentures
infection with candida spp and there is an associated denture stomatitis that should be treated concurrently
angular cheilitis - usual cause if no dentures
more likely to be caused by infection with streptococcus spp or staphylococcus spp
angular cheilitis - what should be done if dentures identified as contributing to problem?
ensure adjusted/new dentures made to avoid problem recurring
cream vs ointment
creams normally used on wet surfaces whereas ointments normally used on dry surfaces
angular cheilitis - first line treatments
miconazole cream 2%
if clearly bacterial in nature - sodium fusidate (fusidic acid) ointment 2%
angular cheilitis - miconazole cream
2%
20g tube
apply to angles of mouth x2 daily
advise pt to continue use for 10 days after lesion has healed
angular cheilitis - miconazole contraindications
warfarin
statins
angular cheilitis - what is miconazole effective against?
both candida and gram positive cocci
angular cheilitis - sodium fusidate (fusidic acid) ointment
2% if clearly bacterial in nature 15g tube apply to angles of mouth x4 daily to avoid development of resistance, don't prescribe for >10days
angular cheilitis - tx for unresponsive cases
miconazole (2%) and hydrocortisone (1%) cream or ointment
30g tube
apply to angles of mouth twice daily
don’t prescribe if taking warfarin/statins
continue use for max 7days / until clinical resolution
angular cheilitis - lack of clinical response could indicate?
predisposing factors e.g. concurrent haematinic deficiency/diabetes
refer to specialist or GP
chronic hyperplastic candidiasis (candidal leukoplakia)
potentially premalignant so refer for tx
why are fluconazole/miconazole preferred over nystatin?
topical anti fungal e.g. nystatin effective against superficial infections but compliance poor because of its unpleasant taste
so miconazole/fluconazole preferred
fungal infections subsequent care
monitor symptoms at follow-up appts
if pt does not respond to appropriate local measures and a course of drug tx or no identifiable cause - refer to a GP or a dental specialist
fungal infections in immunocompromised pts with serious systemic disease require assessment by GP
