Antifungal Drugs

 

AMPHOTERICIN (Amphotericin B):

Indications: Aspergillosis, Blastomycosis, Candidal Endocarditis, Candidal Meningitis, Candidal Septicemia, Candida Peritonitis, Candidemia, Candidiasis, Coccidioidomycosis, Cryptococcal Septicemia, Cryptococcosis, Disseminated Candidiasis, Disseminated Sporotrichosis, Esophageal Candidiasis, Fungal Endocarditis, Fungal Infection of Lung, Fungal Meningitis, Fungal Septicemia, Fungal Urinary Tract Infection, Histoplasmosis, Infectious Disease of Abdomen, Leishmaniasis, Mucormycosis, Pulmonary Cryptococcosis, Rhinocerebral Phycomycosis.

Contraindications: Hypokalemia, Hypomagnesemia, Renal Disease.

Dose and Administration: By intravenous infusion, systemic fungal infections, initial test dose of 1 mg over 20–30 minutes then 250 micrograms/kg daily, gradually increased over 2–4 days, if tolerated, to 1 mg/kg daily; max. (severe infection) 1.5 mg/kg daily or on alternate days. Prolonged treatment usually necessary; if interrupted for longer than 7 days recommence at 250 micrograms/kg daily and increase gradually.

 

 

AMPHOTERICIN B LIPID COMPLEX:

Indications: Cryptococcosis, Disseminated Candidiasis, Mucormycosis, And Refractory Aspergillosis.

Contraindications: Hypokalemia, Hypomagnesemia, Renal Disease.

Dose and Administration: By intravenous infusion, severe invasive candidiasis; severe systemic fungal infections in patients not responding to conventional amphotericin or to other antifungal drugs or where toxicity or renal impairment precludes conventional amphotericin, including invasive aspergillosis, cryptococcal meningitis and disseminated cryptococcosis in HIV patients, adult and child, initial test dose 1 mg over 15 minutes then 5 mg/kg once daily for at least 14 days.

 

FLUCONAZOLE:

Indications: Candidal Urinary Tract Infection, Cryptococcal Meningitis, Disseminated Candidiasis, Esophageal Candidiasis, Mucocutaneous Candidiasis, Oral Candidiasis, Oropharyngeal Candidiasis, Prevention of Disseminated

Candidiasis,                                     Vulvovaginal                                   Candidiasis
Contraindications: Disease of Liver, Prolonged QT Interval, Renal Disease.

Dose and Administration: Vaginal candidiasis and candidal balanitis, by mouth, a single dose of 150 mg. Mucosal candidiasis (except genital), by mouth, 50 mg daily (100 mg daily in unusually difficult infections) given for 7–14 days in oropharyngeal candidiasis (max. 14 days except in severely immunocompromised patients); for 14 days in atrophic oral candidiasis associated with dentures; for 14–30 days in other mucosal infections (e.g. oesophagitis, candiduria, non­invasive bronchopulmonary infections); child by mouth or by intravenous infusion, 3–6 mg/kg on first day then 3 mg/kg daily (every 72 hours in neonate up to 2 weeks old, every 48 hours in neonate 2–4 weeks old). Prevention of fungal infections in immunocompromised patients, by mouth or by intravenous infusion, 50–400 mg daily adjusted according to risk; 400 mg daily if high risk of systemic infections e.g. following bone-marrow transplantation; commence treatment before anticipated onset of neutropenia and continue for 7 days after neutrophil count in desirable range; child according to extent and duration of neutropenia, 3–12 mg/kg daily (every 72 hours in neonate up to 2 weeks old, every 48 hours in neonate 2–4 weeks old); max. 400 mg daily.

 

ITRACONAZOLE:

Indications: Aspergillosis, Blastomycosis, Histoplasmosis, and Onychomycosis due to Dermatophyte.

Contraindications: Chronic Heart Failure, Congenital Long QT Syndrome, Heart Failure, Lactating Mother, Pregnancy, Presumed Infection in Febrile Neutropenic Patient, Torsades de Pointes, Ventricular Arrhythmias.

Dose and Administration: By mouth, oropharyngeal candidiasis, 100 mg once daily (200 mg once daily in AIDS or neutropenia) for 15 days. Vulvovaginal candidiasis, 200 mg twice daily for 1 day. Tinea corporis and tinea cruris, either 100 mg once daily for 15 days or 200 mg once daily for 7 days. Tinea pedis and tinea manuum, either 100 mg once daily for 30 days or 200 mg twice daily for 7 days. Onychomycosis, either 200 mg once daily for 3 months or course (‘pulse’) of 200 mg twice daily for 7 days, subsequent courses repeated after 21-day interval; fingernails 2 courses, toenails 3 courses. Histoplasmosis, 200 mg 1–2 times daily. Systemic aspergillosis, candidiasis and cryptococcosis including cryptococcal meningitis where other antifungal drugs inappropriate or ineffective, 200 mg once daily (candidiasis 100–200 mg once daily) increased in invasive or disseminated disease and in cryptococcal meningitis to 200 mg twice daily.

 

KETOCONAZOLE:

Indications: Blastomycosis, Chromomycosis, Coccidioidomycosis, Disseminated Candidiasis, Histoplasmosis, Oral Candidiasis, Paracoccidioidomycosis, Tinea Corporis, Tinea Cruris, Tinea Pedis, and Tinea Versicolor.

Contraindications: Achlorhydria, Congenital Long QT Syndrome, Disease of Liver, Prolonged QT Interval, Torsades de Pointes.

 

Dose and Administration: 200 mg once daily, increased if response inadequate to 400 mg once daily; continued until symptoms have cleared and cultures negative (usually for 4 weeks in dermatophytoses, 2–3 weeks for oral and cutaneous candidiasis, 1–2 months for hair infections); child body-weight 15–30 kg, 100 mg once daily; body-weight over 30 kg, adult dose. Chronic, recurrent vaginal candidiasis, 400 mg once daily for 5 days.

 

TERBINAFINE:

Indications: Fingernail Onychomycosis, Onychomycosis due to Dermatophyte, Tinea Capitis, Toenail Onychomycosis.

Contraindications: Disease of Liver, Lactating Mother, Alcoholism, Renal Disease, and Systemic Lupus Erythematosus.

Dose and Administration: By mouth, 250 mg daily usually for 2–6 weeks in tinea pedis, 2–4 weeks in tinea cruris, 4 weeks in tinea corporis, 6 weeks–3 months in nail infections. Child usually for 4 weeks, tinea capitis, over 1 year, body-weight 10–20 kg, 62.5 mg once daily; body-weight 20–40 kg, 125 mg once daily; body-weight over 40 kg, 250 mg once daily.

 

NYSTATIN:

Indications: Gastrointestinal Candidiasis, Mucocutaneous Candidiasis, And Oral Candidiasis.

Contraindications: Abdominal Pain with Cramps, Diarrhea, Nausea, and Vomiting.

Dose and Administration: By mouth, intestinal candidiasis 500 000 units every 6 hours, doubled in severe infection; neonate 100 000 units 4 times daily; child 1 month–12 years, 100 000 units 4 times daily; immunocompromised children may require higher doses.

 

About the Author

Pharmacist interested in improving the health outcome for every single case he meets.

>