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SDCEP guidance > fungal infections > Flashcards

fungal infections Flashcards

1
Q

candidiasis (pseudomembranous and erythematous) - predisposing factors

A

inhaled corticosteroids, cytotoxic or broad-spectrum antibacterials
diabetics
nutritional deficiencies
serious systemic disease associated with reduced immunity e.g. leukaemia, other malignancies, HIV

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2
Q

candidiasis (pseudomembranous and erythematous) - when should you refer to specialist/GP?

A

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

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3
Q

candidiasis (pseudomembranous and erythematous) - first tx approach

A

local measures

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4
Q

candidiasis (pseudomembranous and erythematous) - local measures

A

advise pts who use a CS inhaler to rinse their mouth with water or brush their teeth immediately after using the inhaler

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5
Q

candidiasis (pseudomembranous and erythematous) - first line drug tx options

A

fluconazole capsules 50mg

miconazole oromucosal gel 20mg/g

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6
Q

candidiasis (pseudomembranous and erythematous) - fluconazole

A

capsules 50mg
7 capsules x1 daily
can administer for max 14 days for tx of oropharyngeal candidosis

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7
Q

candidiasis (pseudomembranous and erythematous) - fluconazole contraindications

A

warfarin

statins

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8
Q

candidiasis (pseudomembranous and erythematous) - miconazole

A 
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
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9
Q

candidiasis (pseudomembranous and erythematous) - miconazole contraindications

A

warfarin

statins

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10
Q

candidiasis (pseudomembranous and erythematous) - if miconazole and fluconazole contraindicated?

A

nystatin oral suspension 100000 units/ml

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11
Q

candidiasis (pseudomembranous and erythematous) - nystatin

A

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

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12
Q

denture stomatitis - first line tx

A

local measures

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13
Q

denture stomatitis - local measures

A

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

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14
Q

denture stomatitis - what can anti fungal agents be used as?

A

an adjunct

esp to reduce palatal inflammation before taking impressions for new dentures

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15
Q

denture stomatitis - first line antifungals

A

fluconazole capsules

miconazole oromucosal gel

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16
Q

denture stomatitis - fluconazole

A

50mg capsules
7 capsules, x1 daily
max 14 days

17
Q

denture stomatitis - fluconazole contraindications

A

warfarin

statins

18
Q

denture stomatitis - miconazole

A

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

19
Q

denture stomatitis - miconazole contraindications

A

warfarin

statins

20
Q

denture stomatitis - drug tx if fluconazole and miconazole contraindicated

A

nystatin oral suspension 100000units/ml

21
Q

denture stomatitis - nystatin

A

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

22
Q

angular cheilitis - usual cause if dentures

A

infection with candida spp and there is an associated denture stomatitis that should be treated concurrently

23
Q

angular cheilitis - usual cause if no dentures

A

more likely to be caused by infection with streptococcus spp or staphylococcus spp

24
Q

angular cheilitis - what should be done if dentures identified as contributing to problem?

A

ensure adjusted/new dentures made to avoid problem recurring

25
Q

cream vs ointment

A

creams normally used on wet surfaces whereas ointments normally used on dry surfaces

26
Q

angular cheilitis - first line treatments

A

miconazole cream 2%

if clearly bacterial in nature - sodium fusidate (fusidic acid) ointment 2%

27
Q

angular cheilitis - miconazole cream

A

2%
20g tube
apply to angles of mouth x2 daily
advise pt to continue use for 10 days after lesion has healed

28
Q

angular cheilitis - miconazole contraindications

A

warfarin

statins

29
Q

angular cheilitis - what is miconazole effective against?

A

both candida and gram positive cocci

30
Q

angular cheilitis - sodium fusidate (fusidic acid) ointment

A 
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
31
Q

angular cheilitis - tx for unresponsive cases

A

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

32
Q

angular cheilitis - lack of clinical response could indicate?

A

predisposing factors e.g. concurrent haematinic deficiency/diabetes
refer to specialist or GP

33
Q

chronic hyperplastic candidiasis (candidal leukoplakia)

A

potentially premalignant so refer for tx

34
Q

why are fluconazole/miconazole preferred over nystatin?

A

topical anti fungal e.g. nystatin effective against superficial infections but compliance poor because of its unpleasant taste
so miconazole/fluconazole preferred

35
Q

fungal infections subsequent care

A

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

SDCEP guidance (7 decks)

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