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Superficial mycoses in the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
B. P. Glick, M. Zaiac, G. Rebell, N. Zaias
Treatment of dermatophyte infections includes control of local and environmental factors such as moisture and temperature as well as the use of topical and systemic antimycotic therapies. Single or few lesions of tinea infection can best be treated by topical antifungal creams or gels, which tend to serve as a drying agent. Currently available topical antimycotic therapies include topical azoles (e.g. ketoconazole, econazole, oxiconazole and others), ciclopirox olamine, allylamines, (e.g. naftifine, terbinafine) and the newer benzylamines (e.g. Mentax). Azoles are fungistatic and are applied b.i.d. typically for 2 to 4 weeks. Allylamine and benzylamine antimycotics are fungicidal and provide the advantage of reduced dosing frequency and overall duration of therapy, usually 1 to 2 weeks8,9.
Skin infections
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
Tinea capitis should be treated with oral griseofulvin (10 mg/kg body weight per day for 6 weeks); topical antifungal agents such as ketoconazole shampoo may reduce transmission, but are ineffective at treating tinea capitis. For ordinary ringworm of hairy skin, an imidazole-containing preparation (such as miconazole, econazole and clotrimazole) used twice daily for a 3–4-week period is usually adequate. Topical allylamines such as terbinafine are also effective.
History of antifungals
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Emily L. Larkin, Ali Abdul Lattif Ali, Kim Swindell
Superficial fungal infections, such as cutaneous and mucosal candidiasis, dermatophytoses, and tinea versicolor are among the most frequently encountered infections world-wide [98,99]. These infections are commonly caused by Candida, Trichophyton, Microsporum, and Malassezia species and most often involve the skin, nails, buccal or vaginal mucosa, or eyes [98]. Historically, compounds such as gentian violet and Balsam of Peru were used for topical antifungal therapy. However, in the past decades, fungistatic azole drugs with imidazole- and triazole-containing compounds (e.g., miconazole and itraconazole, respectively) have been the mainstay of topical antifungal therapy [100,101]. The advent of fungicidal allylamines (e.g., terbinafine) has improved treatment outcomes, as cure rates are higher with fungicidal drugs. Other new agents such as topical echinocandins (caspofungin), ciclopirox, efinaconazole, and tavaborole offer additional options for the treatment of superficial fungal infections [102–104].
Existing and emerging therapies for the treatment of invasive candidiasis and candidemia
Published in Expert Opinion on Emerging Drugs, 2022
David De Bels, Evelyne Maillart, Françoise Van Bambeke, Sebastien Redant, Patrick M. Honoré
The mode of action of the four families of existing drugs active against Candida is shown in Figure 1. Polyenes, azoles and echinocandins are the three main classes of antifungal drugs proposed for the treatment of invasive candidiasis. Flucytosine is anecdotally used and never in monotherapy. The allylamine terbinafine is considered inadequate for treating Candida infections. The choice of the best therapeutic option for each individual patient is critical because invasive Candida infections are associated with a non-negligible mortality. Retrospective studies showed that the early treatment of invasive candidiasis and candidemia by anti-fungal drugs and the control of the source of the infection are essential as they seem to contribute to decrease mortality. In a first retrospective study including 230 patients, mortality was 15% when fluconazole was started the day of the first positive blood culture but rose to 41% if started 3 days later (p ≤ 0.0009) [43]. A second study showed a 2-fold increase in mortality when patients received anti-fungal treatment more than 12 hours after sampling [44]. These data highlight the interest of non-culture diagnoses. Prediction tools based on clinical risk factors, the presence of candida colonization, and the β-D-glucan screening test have been proposed, but their clinical usefulness is doubtful due to the low prevalence of invasive candidiasis. To date no studies have permitted to show their interest for reducing mortality or length of stay.
Efinaconazole topical solution (10%) for the treatment of onychomycosis in adult and pediatric patients
Published in Expert Review of Anti-infective Therapy, 2022
Tracey C. Vlahovic, Aditya K. Gupta
Onychomycosis can be managed in several ways: pharmaceutically, mechanically (via nail debridement or laser therapy), and surgically. Compared to nail debridement and surgical avulsion of the nail, the pharmaceutical agents have robust data showing mycological cure. From a pharmaceutical perspective, oral or systemic antifungal options and topical options are available on the market. Systemic antifungals are currently assumed to be the most effective treatment for onychomycosis according to meta-analyses conducted [35]. Oral antifungal agents (e.g. terbinafine [an allylamine] and itraconazole [an imidazole]) are considered treatments of choice for onychomycosis because they can effectively reach the nail bed through systemic circulation [36]. However, these agents have limitations including: drug-drug interactions with agents that are metabolized by specific cytochrome P450 (CYP) enzymes (more often itraconazole), potential inhibition of certain CYP subtypes, and adverse effects such as congestive heart failure and hepatotoxicity, the latter of which requires liver functioning tests completed prior to initiation of therapy [29,30,36]. Itraconazole has boxed warnings of rare cases of serious hepatotoxicity with treatment, including liver failure and death. Even patients with no preexisting liver disease or serious underlying medical condition are at risk for hepatotoxicity as well as congestive heart failure [30]. Fosravuconazole (BFE1224) is an oral triazole antifungal agent approved for the treatment of onychomycosis in Japan [37], though it is not approved in the US.
Nanotechnological interventions in dermatophytosis: from oral to topical, a fresh perspective
Published in Expert Opinion on Drug Delivery, 2019
Riya Bangia, Gajanand Sharma, Sunil Dogra, Om Prakash Katare
The allylamines include drugs, namely, naftifine and terbinafine. These drugs are active against dermatophytes when used in a concentration of 1% in a cream base. Results have been achieved in the successful management of superficial mycotic infections, in as earlier as 1 week. Although they show good tolerance, contact allergy may occur rarely [27,28]. Cochrane review witnessed efficacy of topical 1% naftifine as compared to the placebo with few adverse effects; however, the evidence was low [29]. All allylamines, including terbinafine, naftifine, butenafine, act by similar mechanism of action, by inhibiting squalene epoxidase, which is required for ergosterol synthesis in dermatophytes (Figure 1). As a result of squalene epoxidase inhibition, intracellular accumulation of toxic squalene occurs in the fungi. These high intracellular squalene concentrations interfere with fungal membrane function as well as cell wall synthesis, thus leading to cidal action and fungal death [30].