Oral Infections (fungal) Flashcards
What is the main cause of fungal mouth infections?
Candida sp.
What are the 5 main manifestations of oral candida infection?
- Thrush (acute pseudomembranous candidiasis)
- Acute erythematous (atrophic) candidiasis
- Denture stomatitis
- Chronic hyperplastic candidiasis
- Angular chelitis (angular stomatitis)
What is the management of choice for thrush (acute pseudomembranous candidiasis)?
Management of predisposing conditions
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FIRST LINE:
- nystatin
- miconazole
SECOND LINE:
- Fluconazole
What are some predisposing conditions to thrush? (5)
- Use of inhaled corticosteroids
- Use of cytotoxic drugs
- Use of broad-spectrum antibiotics
- Leukemia or other malignancies
- HIV
How should thrush be managed in a patient taking inhaled corticosteroids?
Advise to rinse mouth or brush teeth immediately after using the inhaler
What causes acute erythematous candidiasis? (3)
Relatively uncommon condition associated with:
- corticosteroid use
- broad spectrum abx use
- HIV
What is the treatment of choice for acute erythematous candidiasis?
Fluconazole
What is the treatment of choice for denture stomatitis (chronic atrophic candidiasis)?
Miconazole oral gel
- patients should cleanse their dentures thoroughly and leave them out as often as possible during the treatment period. To prevent recurrence of the problem, dentures should not normally be worn at night. New dentures may be required if these measures fail despite good compliance
In addition to appropriate pharmacotherapy, what advice should be given to patients suffering from denture stomatitis (chronic atrophic candidiasis)?
- Patients should cleanse their dentures thoroughly and leave them out as often as possible during the treatment period
- To prevent recurrence of the problem, dentures should not normally be worn at night.
- New dentures may be required if these measures fail despite good compliance
What are potential causes of denture stomatitis other than candida? (3)
- Chemical or mechanical irritation
- Bacterial infection
- Rarely, allergy to the dental base material
What is the management of chronic hyperplastic candidiasis (candidal leukoplakia)?
Biopsy is essential due to the increased risk of malignancy
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Systemic fluconazole to eliminate candidal overlay
*patients should be advised to avoid tobacco
What are the causes of angular cheilitis (angular stomatitis)?
Commonly associated with:
- denture stomatitis
- nutritional deficiency
- orofacial granulomatosis
- HIV
- candida infection
- bacterial infection (staph or strep)
**often multiple, interacting factors
Why are elderly patients predisposed to angular cheilitis (angular stomatitis)
A reduction in facial height related to ageing and tooth loss with maceration in the deep occlusive folds that may subsequently arise, predisposes to infection with yeast (candida) and/or bacteria (staph or strep)
What is the empirical treatment of angular cheilitis (angular stomatitis)?
(While underlying cause is being identified and treated, one of the following may be tried…)
FIRST LINE:
- Miconazole cream OR
- Fusidic acid ointment
SECOND LINE: (if unresponsive to initial treatment)
- hydrocortisone with miconazole cream
Is nystatin absorbed by the GI tract?
No; applied to the mouth as a suspension to treat local fungal infection
How is miconazole applied in the treatment of oral fungal infections?
Applied as an oral gel; miconazole is absorbed by the GIT so potential drug interactions should be taken into account
Does miconazole have any antibacterial properties?
Yes; active against some gram-positive bacterial including staph and strep
How is fluconazole applied when treating oral fungal infections?
Taken orally for infections that do not respond to topical therapy or when topical therapy cannot be used; reliably absorbed by the GIT and effective
When is itraconazole indicated in the treatment of oral fungal infections?
When infections do not respond to fluconazole
How should patients be managed when candidal infection fails to respond to 1-2 weeks of treatment with antifungal drugs?
Patient should be sent for investigation to eliminate the possibility of underlying disease; also consider re-infection from genito-urinary or GI disease as well as partner re-infection
What is the method of oral candidiasis prevention in immunocompromised patients?
Antiseptic mouthwash
What is the main contraindication to the use of fluconazole?
Acute porphyrias
Do azole drugs have any notable drug interactions?
Yes, MANY. Azole antifungals are substrates for and inhibitors of CYP450 enzymes and therefor interact with MANY other drugs
What is the main drug interaction to avoid when prescribing fusidic acid?
Statins! Fusidic acid has been reported to cause rhabdomyolysis when given with statins
Can fusidic acid be used topically for eye infections?
NO; avoid contact of cream or ointment with eyes
How long can topical fusidic acid be used?
Max 10 days to avoid development of resistance
Can fluconazole be administered during pregnancy?
No, risk of fetal malformation
In which patients should fluconazole be administered with caution?
Patients with liver disease (risk of hepatotoxicity)
