fungal infections

Question 1

aspergillosis, cryptococcosis, thrush and skin/nail infections treatment

Answer 1

aspergillosis - voriconazole

cryptococcosis - amphotericin B

thrush:
- vaginal - clotrimazole/fluconazole (resistant - itraconazole)
- oral - nystatin/miconazole/fluconazole (resistant itraconazole)

skin/nail - topical
- systemic itraconazole/terbinafine

Question 2

tinea (ringworm) imp points

Answer 2

tinea capitis - head
tinea corporis - body
tinea cruris - groin
tinea pedis - feet
tinea unguium/onychomycosis - nails
- treat with topical antifungal cream or terbinafine

nail region - terbinafine or amorolfine nail lacquer
- once weekly for 1 year - as nail is growing out
- refer if <18, >2 nails affected, diabetic, pregnant/breastfeeding

Question 3

antifungal medications

Answer 3

fluconazole itraconazole ketoconazole voriconazole
- QT prolongation and HEPATOTOXIC
- least risk in fluconazole, most in ketoconazole

itraconazole - carbonated drinks improve bioavailability

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

voriconazole - phototoxicity - avoid sunlight exposure

amphotericin B
- caution in renal failure
- anaphylaxis risk in IV amphotericin B - test dose with 30 min observation
- prophylactic anti-pyretics or hydrocortisone in pts with prev reactions
- maintain same formulation b/w conventional, liposomal, lipid complex formulations - harm/fatal overdoses have occured

terbinafine - hepatotoxic