- Sexual factors - Contraceptive agents - Host factors (Pregnancy or diabetes) - Medications (abx or SGL2 inhibitors)

- Convenient - Long half life (30hrs) - Renally eliminated

- OTC products available - Administer vaginally only - Oral administration is TOXIC

Superficial Fungal Infections (Perez) Flashcards by Madison Denny

Vulvovaginal candidiasis (VVC) most common pathogen

-Candida albicans

80-90%

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VVC Risk Factors

Sexual factors
Contraceptive agents
Host factors (Pregnancy or diabetes)
Medications (abx or SGL2 inhibitors)

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If VVC is asymptomatic do you treat?

-No ya dingus!

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Definition of Uncomplicated VVC

Mild/mod signs/symptoms
Infrequent (< 3 episodes /year)
Immunocompetent
NOT pregnant

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Treatment of uncomplicated VVC

-Usually an Azole

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Definition of Complicated VVC

Immunocrompromised
Pts with uncontrolled diabetes
Pregnant patients

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How to treat complicated VVC

-Azole antifungals

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Recurrent VVC definition and treatment

> /= 4 episodes with in 12 months

- Treatment: put a maintenance Azole antifungal on board

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Which fungi in VVC is most likely to have antifungal resistance

Candida glabrata
1) higher prevalence in pts with diabetes
2) higher cure rates when boric acid vaginal suppositories are used

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Fluconazole

Convenient
Long half life (30hrs)
Renally eliminated

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Boric Acid Supp.

OTC products available
Administer vaginally only
Oral administration is TOXIC

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Non-pharm recommendations for VVC

Avoid: 
-Harsh soaps
-Constrictive clothing
-Don't use a douche 
Do this:
-Keep area clean and dry
-Cool baths to soothe skin

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Treatment of Uncomplicated VVC

Clotrimazole (Gyne-Lotrimin)
Miconazole (Monistat)
Tioconazole (Vagistat)
Terconazole
Butoconazole (Gynazole)
Fluconazole (diflucan)

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Treatment of Complicated VVC in pts with DM or immunocompromised

Oral fluconazole (Q72hrs for 2 to 3 doses)

- Topical azole antifungal (7-14 days)

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Treatment of complicated VVC in pregnant pts

Topical clotrimazole
Topical Miconazole
Both have 7 day LOT

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Treatment of recurrent VVC

1) Introduction
-Oral fluconazole
or
-Topical Azole antifungal
2) Maintenance
-Fluconazole 150mg weekly for 6mo

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Treatment of Antifungal resistant VVC

Boric acid supp.
1 supp. daily for 14 days
Followed by 1 supp twice weekly

What is the most common pathogen in Oropharyngeal candidiasis (OPC)

-Candida albicans

What are the most common opportunistic infections in HIV/AIDS

Oropharyngeal Candidiasis (OPC)

- Esophageal Candidiasis (EPC)

Risk factors for OPC/EPC

Local
Systemic
Diabetes
Nutritional deficiencies

Clinical Pearls for Clotrimazole troches

Doesn’t work well in people with dry mouth
Contains dextrose
Can cause tooth decay

Clinical Pearls for Miconazole buccal tablets

Once daily admin (Dope)
Sugar free
Difficult to keep in place (bad)
Currently brand only (expensive?)

Nystatin Suspension Clinical pearls

Unpleasant taste
High sucrose content
Tooth decay
Caution in pts with diabetes

Itraconazole solution clinical pearls

Swish and swallow
Take on empty stomach
More expensive than fluconazole

Posaconazole (Noxafil)

- Shake before use (suspension) - Take with meal - No generic currently - More expensive than fluconazole

Voriconazole tablets

- Take on empty stomach - Visual disturbances/hallucinations - More expensive than fluconazole

IV Echinocandins (Micafungin, caspofungin, anidulafungin)

- Fever, headache - Infusion related reactions - Liver damage

IV amphotericin B Deoxycholate

- Fevers, chills - Nephrotoxicity - Electrolyte disturbances - Bone marrow suppression

Duration of therapy for OPC

-7 to 14 days

Initial treatment for mild OPC

1) Clotrimazole 2) Miconazole 3) Nystatin

Initial treatment for moderate to sever OPC

1) Fluconazole 2) Itraconazole 3) Posaconazole 4) Voriconazole

Duration of therapy for ECP

-14 to 21 days

Initial treatment for ECP

- Fluconazole - Micafungin - Capsofungin - Anidulafungin

Treatment of recurrent ECP

-Fluconazole

Most common pathogens in Dermatophyte infetions

- Trichophyton - Microsporum - Epidermophyton - Malassezia (Tinea versicolor)

Risk factors for Dermatophyte infections

- prolonged exposure to sweat or water - maceration - intertiginous folds - sharing personal belongings - close living quarters

Tinea Corporis (ringworm)

- More common in children - Treat with topical antifungal - Nonpharm: don't share towels, wash sheets and towels, change clothes ofter

Tinea Cruris (Jock itch)

- More common in males - Topical treatment is usually sufficient - Nonpharm: keep dry an avoid long exposure to moisture

Tinea Versicolor

- Topical treatment is usually adequate unless there is 1) extensive involvement 2) recurrent infections 3) topical therapy has failed

Tinea Pedis

- Topical treatment should suffice | - Nonpharm: disinfect footwear, avoid walking bear foot in public places, wear absorbent socks

Tinea Unguium (Onychomycosis-nails_

- first line treatment = Terbinafine | - systemic drug works better than topical in this case