Therapeutics - Fungus 2
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What is Terbinafine usually used for?
- Toe and fingernail infections
What is the half life of Terbinafine?
Does Terbinafine have good Bioavailability?
Decent w/ or w/o food
What are the risk factors for vulvovaginal candidiasis?
- Sexual factors
- Oral contraceptives
What is the most common vulvovaginal fungal infecting agent?
What are the S/S of Vulvovaginal candidiasis?
- Cheese like discharge
- Vulvar itch
- Burning upon urination
- Normal Vaginal pH
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
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?
What are the risk factors for Thrush/Oropharyngeal candidiasis?
- Steroids/Antibiotics (Inhalers/Advair, etc.)
- Immunosuppression (HIV, Cancer, DM)
- Nutritional deficiencies
What are the S/S of Thrush/Oropharyngeal candidiasis?
- White patches on surface
- Metallic taste
What is a good way to treat thrush in small children/infants?
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
What is the dose for Fluconazole in the treatment of thrush?
100 mg QD 7-14 days
How long should you treat Onchomycosis?
- Fingernail: 6 weeks
- Toenail: 12 weeks
How is Onychomycosis treated?
- Terbinafine 250 mg/day x6-12 weeks
- Itraconazole 200 mg PO BID x 1 week/month (repeat 2x for finger, 3x for toe)
What are the risk factors for Systemic Candidiasis?
- Indwelling catheter/IV line
- Broad-spectrum antibiotics
- TPN therapy
- IV drug users
- Immunocompromised (Neutropenic, Immunosuppressed, HIV/AIDS)
How does systemic candidiasis present?
- Acute onset of fever
- Worsening deterioration w/ or w/o fever
- (Like sepsis)
How would you Usually treat systemic Candidia in an ImmunoCOMPETENT adult?
- Fluconazole 800 mg loading dose
- 400 mg IV thereafter
- 14 days
How would you Usually treat systemic Candidia in an ImmunoCOMPRIMISED adult?
What are the ALTERNATIVE treatments for Systemic Candida in an ImmunoCOMPETENT adult?
What are the ALTERNATIVE treatments for systemic Candida in an ImmunoCOMPRIMISED adult?
- (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
In general Candida albicans should be treated with _______________________ if at all possible.
Fluconazole or echinocandin
What type of antifungal should be used to treat commonly resistant C. glabrata?
What type of antifungal should be used to treat commonly resistant C. krusei?
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.)
What would you like to do?
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