Fungal infections Flashcards
whats the first line treatment for aspergillosis?
1) Voriconazole
2) liposomal amphotericin is an alternative first-line when the above cant be used
how is vaginal candidiasis treated?
vaginal candidiasis may be treated with locally acting antifungals or with fluconazole
2) for resistant organisms itraconazole
how is Oropharyngeal candidiasis treated?
1) Topical therapy, fluconazole is given by mouth for unresponsive infections.
2) Itraconazole if fluconazole fails
how is invasive or disseminated candidiasis treated?
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
whats the treatment of choice in cryptococcal meningitis?
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
what is the treatment for histoplasmosis?
1) Itraconazole
2) Amphotericin by IV infusion for the initial treatment of fulminant or severe infections, followed by a course of itraconazole by mouth
outline how mild localised fungal infections of the skin (including tinea corporis, tinea cruris, and tinea pedis) are treated
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).
which oral antifungals are normally used for skin and nail infections?
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
how is Tinea capitis is treated ?
1) Systemically; additional topical application may reduce transmission
2) Griseofulvin is used for tinea capitis in adults and children
how is Pityriasis versicolor may be treated
1) itraconazole by mouth if topical therapy is ineffective;
2) fluconazole by mouth is an alternative.
(Oral terbinafine is not effective)
how are patients with tinea infection of the nails namaged?
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
immunocompromised patients are at particular risk of fungal infections and may receive antifungal drugs prophylactically. which drugs are first line?
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
list the triazole antifungals
Fluconazole, Itraconazole, Posaconazole , Voriconazole
outline the characteristics of Fluconazole
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
outline the characteristics of Itraconazole
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
