Fungal Infections

Question 1

Candida albicans (oral thrush)

Answer 1

Mild: (local agents)
Clotrimazole (lozenge)
Nystatin (suspension)
Micronazole

Local agents: keep in mouth as long as possible

Moderate-Severe or HIV+:
Fluconazole
- Do not use in pregnancy.
- Requires renal adjustment

Question 2

Candida albicans (esophageal infection)

Answer 2

First line:
Fluconazole
- Used in oral, esophageal, vaginal yeast infections

Alternative:
Echinocandin

Question 3

Candida krusei + glabrata (azole resistant candida)

Answer 3

First line:
Echinocandin
- Only available as injection
- Well tolerated and not associated with significant renal or hepatic toxicity

Alternative:
Amphotericin B

Question 4

Aspergillus

Answer 4

First line:
Voriconazole
- Oral therapy preferred
- If IV is used: CrCl <50 ml/min SBECD accumulates
- Visual changes and photosensitivity

Alternative:
Amphotericin B

Question 5

Cryptococcus neoformans (meningitis)

Answer 5

First line:
Amphotericin B + flucytosine
- Amphotericin: decreases K and Mg and nephrotoxicity
- Flucytosine: myelosuppression

Alternative:
HD fluconazole + flucytosine

Question 6

Dermatophytes (nail bed infection)

Answer 6

First line:
Terbinafine or Itraconazole
- confirm fungal infection prior to treatment
- Terbinafine: hepatotoxicity
- Itraconazole: QT prolongation, Hepatotoxicity, DO NOT USE IN HF

Alternative:
Fluconazole