FUNGAL INFECTIONS

Question 1

Aspergillosis

Answer 1

Voriconazole

Question 2

Cryptococcosis

Answer 2

Amphotericin B

Question 3

Oral thrush

Answer 3

1st line = miconazole (daktarin) gel
2nd line = nystatin
Extensive/severe = oral fluconazole
Resistant: Itraconazole

Question 4

Vaginal thrush

Answer 4

Caused by candida albicans
1st line = oral azole (fluconazole or itraconazole)
2nd line = intravaginal imidazole pessary or cream (clotrimazole)
Topical antifungal cream can be used to treat superficial symptoms.
o Resistant: Itraconazole

Question 5

Intravaginal pessary

Answer 5

Local irritation may occur - can be mistaken for treatment failure
Can repeat after 7 days if no improvement

Question 6

Pregnancy

Answer 6

DO NOT give oral azoles
Treatment with intravaginal pessaries - longer duration of treatment (7 days) may eb required.
Counsel pt not to use applicator

Question 7

Skin and nail infections

Answer 7

• Topical therapy → Systemic therapy (itraconazole, terbinafine)

Question 8

Tinea

Answer 8

ringworm

Question 9

Tinea capitis

Answer 9

head

Question 10

tinea corporis

Answer 10

body

Question 11

tinea cruris

Answer 11

groin

Question 12

tinea pedis

Answer 12

feet

Question 13

tinea ungium/ onchomycosis

Answer 13

nails

Question 14

Treatment for tinea

Answer 14

• Treat with topical antifungal cream or terbinafine
• Nail region terbinafine or amorolfine nail lacquer
• Once weekly for up to 1 year

Question 15

Referral for tinea

Answer 15

• under 18
• more than 2 nails affected
• diabetic
• pregnant / breastfeeding

Question 16

Fluconazole, Itraconazole, Ketoconazole + Voriconazole

Answer 16

• QT prolongation and hepatotoxicity
• Less risk in fluconazole, more risk in ketoconazole, voriconazole and itraconazole

Question 17

Itraconazole

Answer 17

• Carbonated drinks improves itraconazole bioavailability

Question 18

Ketoconazole

Answer 18

• Life threatening hepatotoxicity - oral treatment suspended (CHMP advice)

Question 19

Voriconazole

Answer 19

• Phototoxicity occurs uncommonly - avoid sunlight exposure

Question 20

Amphotericin B


Answer 20

• Caution in renal failure

• Anaphylaxis risk in IV amphotericin B

Question 21

Amphotericin B formulation

Answer 21

Maintain same formulation between conventional, liposomal and lipid-complex formulations - Serious harm and fatal overdoses have occurred

Question 22

Amphotericin B anaphylaxis risk

Answer 22

Test dose with 30 minutes observation
o Prophylactic antipyretics or hydrocortisone in patients with previous reactions

Question 23

Terbinafine

Answer 23

Hepatotoxicity