Fungal infections

Question 1

whats the first line treatment for aspergillosis?

Answer 1

1) Voriconazole

2) liposomal amphotericin is an alternative first-line when the above cant be used

Question 2

how is vaginal candidiasis treated?

Answer 2

vaginal candidiasis may be treated with locally acting antifungals or with fluconazole
2) for resistant organisms itraconazole

Question 3

how is Oropharyngeal candidiasis treated?

Answer 3

1) Topical therapy, fluconazole is given by mouth for unresponsive infections.
2) Itraconazole if fluconazole fails

Question 4

how is invasive or disseminated candidiasis treated?

Answer 4

1) Echinocandin can be used
2) Fluconazole is an alternative for Candida albicans
3) amphotericin should be considered for the initial treatment of CNS candidiasis

Question 5

whats the treatment of choice in cryptococcal meningitis?

Answer 5

1) Amphotericin and flucytosine by intravenous infusion for 2 weeks
2) Followed by fluconazole by mouth for 8 weeks or until cultures are negative
3) Following successful treatment, fluconazole can be used for prophylaxis

Question 6

what is the treatment for histoplasmosis?

Answer 6

1) Itraconazole
2) Amphotericin by IV infusion for the initial treatment of fulminant or severe infections, followed by a course of itraconazole by mouth

Question 7

outline how mild localised fungal infections of the skin (including tinea corporis, tinea cruris, and tinea pedis) are treated

Answer 7

1) respond to topical therapy.
2) Systemic therapy is appropriate if topical therapy fails, if many areas are affected, or if the site of infection is difficult to treat such as in infections of the nails (onychomycosis) and of the scalp (tinea capitis).

Question 8

which oral antifungals are normally used for skin and nail infections?

Answer 8

1) Oral imidazole or triazole (particularly itraconazole) and terbinafine - they are broader spectrum and require a shorter duration of treatment.
2) griseofulvin not used frequently

Question 9

how is Tinea capitis is treated ?

Answer 9

1) Systemically; additional topical application may reduce transmission
2) Griseofulvin is used for tinea capitis in adults and children

Question 10

how is Pityriasis versicolor may be treated

Answer 10

1) itraconazole by mouth if topical therapy is ineffective;
2) fluconazole by mouth is an alternative.
(Oral terbinafine is not effective)

Question 11

how are patients with tinea infection of the nails namaged?

Answer 11

1) asymptomatic patients may not need treatment
2) if treatment needed, systemic more effective
3) Terbinafine first line, and itraconazole for the systemic treatment of onychomycosis

Question 12

immunocompromised patients are at particular risk of fungal infections and may receive antifungal drugs prophylactically. which drugs are first line?

Answer 12

1) oral triazole antifungals are the drugs of choice for prophylaxis.
2) Fluconazole reliably absorbed than itraconazole, but not effective against Aspergillus spp. Itraconazole can be used in this case
3) Amphotericin by IV infusion or caspofungin (not for CNS) is used for treatment of serious fungal infections

Question 13

list the triazole antifungals

Answer 13

Fluconazole, Itraconazole, Posaconazole , Voriconazole

Question 14

outline the characteristics of Fluconazole

Answer 14

1) Fluconazole, well absorbed, achieves good penetration into cerebrospinal fluid to treat fungal
2) excreted largely unchanged in the urine and can be used to treat candiduria.
3) =less frequently associated with hepatotoxicity

Question 15

outline the characteristics of Itraconazole

Answer 15

1) active against dermatophytes, capsules require an acid environment in the stomach for optimal absorption.
2) been associated with liver damage and should be avoided or used with caution in patients with liver disease

Question 16

what is Posaconazole licenced for?

Answer 16

treatment of invasive fungal infections unresponsive to conventional treatment.

Question 17

Imidazole antifungals are used for local vaginal candidiasis and for dermatophyte infections. list the drugs in this class

Answer 17

1) clotrimazole
2) ketoconazole
3) Miconazole
4) econazole nitrate
5) tioconazole

Question 18

list the Polyene antifungals and state their characteristics

Answer 18

amphotericin and nystatin- neither drug is absorbed when given by mouth.

Question 19

what is nystatin indicated for?

Answer 19

1) oral, oropharyngeal, and perioral infections by local application in the mouth.
2) Nystatin is also used for Candida albicans infection of the skin.

Question 20

amphotericin is used for treatment of systemic fungal infections and is active against most fungi and yeasts. It is highly protein bound and penetrates poorly into body fluids and tissues. how are its toxic side effects managed?

Answer 20

1) Lipid formulations of amphotericin (Abelcet® and AmBisome®) less toxic and used when amphotericin is contra-indicated because of toxicity, especially nephrotoxicity
2) lipid formulations more expensive

Question 21

1) list the Echinocandin antifungals?

2) what are these active against?

Answer 21

1) Anidulafungin, caspofungin and micafungin- only active against Aspergillus spp. and Candida spp.
3) Anidulafungin and micafungin not used for the treatment of aspergillosis.
3) Echinocandins not effective for CNS fungal infections

Question 22

what is the drug of choice for fungal nail infections where oral treatment is considered appropriate?

Answer 22

Terbinafine is the drug of choice for fungal nail infections and is also used for ringworm infections