-
What is Terbinafine usually used for?
- Dermatophytes
- Toe and fingernail infections
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What is the half life of Terbinafine?
400 hours
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Does Terbinafine have good Bioavailability?
Decent w/ or w/o food
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What are the risk factors for vulvovaginal candidiasis?
- Sexual factors
- Oral contraceptives
- Antibiotics
-
What is the most common vulvovaginal fungal infecting agent?
Candidia albicans
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What are the S/S of Vulvovaginal candidiasis?
- Erythemia
- Cheese like discharge
- Edema
- Vulvar itch
- Irritation
- Burning upon urination
- Normal Vaginal pH
- Pseudohyphae
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What are the treatments for uncomplicated vulvovaginal candidiasis?
- Topical azoles: Clotimazole, Miconazole cream/suppository or ovule or Ticonazole
- Oral azoles: Fluconazole (150 x1) or Itraconazole (200 BID x1)
- Nystatin 100,000 U tab
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What is the DOC for OTC treatment of Vulvovaginal Canididasis?
None, all are equivalent
-
How should you treat complicated vuvlovaginal candidiasis?
- 7-14 days
- Consider: Fluconazole 150 mg PO Q72H x3 doses
-
What is recurrent vulvovaginal candidiasis?
> 4 in 12 months
-
How do you treat recurrent vulvovaginal candidiasis?
- Indiction: Fluconazole 150 mg PO Q72H x 3 doses
- Maintenance: 150 mg QW x 6 months
-
What is the most common etiology of oropharyngeal candidiasis?
Candida albicans
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What are the risk factors for Thrush/Oropharyngeal candidiasis?
- Steroids/Antibiotics (Inhalers/Advair, etc.)
- Smoking
- Chemotherapy/Radiation
- Immunosuppression (HIV, Cancer, DM)
- Nutritional deficiencies
-
What are the S/S of Thrush/Oropharyngeal candidiasis?
- Variable
- Erythema
- White patches on surface
- Pain
- Metallic taste
- Dysphagia
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What is a good way to treat thrush in small children/infants?
Gentian violet
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What drugs are used to treat Oropharyngeal Candidiasis?
- Uncomplicated: Nystain or Clotrimazle
- Moderate to Severe disease: Fluconazole
- Refractory or High Risk: Vori, Itra, POsa or AmB systemic therapy
-
What is the dose for Nystatin in the treatment of thrush?
- 100,000 U/mL
- 5 mL swish/spit/swallow sometimes
- QID for 7-14 days
-
What is the dose for Clomitrazole in the treatment of thrush?
- 10 mg troche
- Slowly dissolve in mouth for 15-20 minutes 4-5 x day
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What is the dose for Fluconazole in the treatment of thrush?
100 mg QD 7-14 days
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How long should you treat Onchomycosis?
- Fingernail: 6 weeks
- Toenail: 12 weeks
-
How is Onychomycosis treated?
- Orally
- Terbinafine 250 mg/day x6-12 weeks
- Itraconazole 200 mg PO BID x 1 week/month (repeat 2x for finger, 3x for toe)
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What are the risk factors for Systemic Candidiasis?
- Indwelling catheter/IV line
- Surgery
- Broad-spectrum antibiotics
- TPN therapy
- IV drug users
- Immunocompromised (Neutropenic, Immunosuppressed, HIV/AIDS)
-
How does systemic candidiasis present?
- Acute onset of fever
- Tachycardia
- Tachypnea
- Hypotension
- Worsening deterioration w/ or w/o fever
- (Like sepsis)
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How would you Usually treat systemic Candidia in an ImmunoCOMPETENT adult?
- Fluconazole 800 mg loading dose
- 400 mg IV thereafter
- OR
- Echinocandin
- 14 days
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How would you Usually treat systemic Candidia in an ImmunoCOMPRIMISED adult?
- Echinocandin
- Or
- Amphotericin
-
What are the ALTERNATIVE treatments for Systemic Candida in an ImmunoCOMPETENT adult?
-
What are the ALTERNATIVE treatments for systemic Candida in an ImmunoCOMPRIMISED adult?
- Fluconazole
- Voriconazole
- (Only if no previous azole exposure and not critically ill)
-
How would you treat SEVERE Systemic Candida in an ImmunoCOMPETENT adult?
Echinochandin x 14 days
-
How would you treat Systemic Candida in an ImmunoCOMPETENT adult who has recently been exposed to an azole?
Echinochandin x 14 days
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In general Candida albicans should be treated with _______________________ if at all possible.
Fluconazole or echinocandin
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What type of antifungal should be used to treat commonly resistant C. glabrata?
Echinocandin preferred
-
What type of antifungal should be used to treat commonly resistant C. krusei?
Echinocandin preferred
-
What type of antifungal should be used to treat commonly resistant C. lusitaniae?
Fluconazole (tends to be resistant to amphoB)
-
Voriconazole should be reserved for what situation?
Step-down cases of C. glabrata or C. krusei (fluconazole resistant sp.)
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