Candida and parasitic infection: Helminths, trichomoniasis, lice, scabies, and malaria
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Treatment of Candida vulvovaginitis in pregnancy is typically limited to topical azoles and nystatin (16,25). For many years, nystatin was the primary drug used for Candida vulvovaginitis in pregnancy because its extremely poor absorption was felt to improve its safety (pregnancy category B) (25). As studies have proven, the increased efficacy of the azole antifungal agents, miconazole, clotrimazole, butoconazole, and terconazole, has become the mainstays of therapy in pregnancy. They have been used extensively in human pregnancy with no adverse effects or increase in congenital malformations noted, but most remain pregnancy category C due to the absence of adequate controlled human studies. There is no clear leader from this group in terms of efficacy and patient satisfaction, so selection may be based on availability and cost. Seven-day treatment is usually needed in pregnancy due to the higher rates of treatment failure and recurrence. Cure rates are typically 5% to 10% lower than those in nonpregnant women for the same dosing regimen.
Investigational Nanomedicines in 2016: A Review of Nanotherapeutics Currently Undergoing Clinical Trials *
Valerio Voliani in Nanomaterials and Neoplasms, 2021
Aronex pharmaceuticals is developing a liposomal formulation of nystatin called Nyotran. Nystatin is a potent antifugal drug and has shown additive toxicity with other antifungal agents including amphotericin B, itraconazole, and flucytosine with various fungal cultures. Unfortunately, nystatin is of limited value as a systemic therapy because of significant toxicities including nephrotoxicity, cardiopulmonary instability, and extreme cutaneous reactions including Stevens-Johnsons syndrome [64]. The liposomal formulation Nyotran has been well tolerated in early phase clinical trials and has completed a phase III trial which randomized neutropenic patients with presumed fungal infections to amphotericin B or Nyotran. The authors presented the results of a modified intention to treat analysis of 131 patients (out of a total 538) demonstrating similar efficacy with less renal toxicity than amphotericin B. Additional studies are ongoing and Aronex plans to file a new drug application (NDA) in the near future.
Antifungal Drugs and Susceptibility Testing of Fungi
Rossana de Aguiar Cordeiro in Pocket Guide to Mycological Diagnosis, 2019
Since the 1950s, the fungicidal polyenes, such as nystatin and amphotericin B, have been used as a powerful but highly toxic last line of defense against invasive fungal infections. These are amphipathic fungicidal drugs consisting of a hydrophobic polyene hydrocarbon chain and a hydrophilic polyhydroxyl chain. For decades, the prevailing theory was that these molecules directly bound to the ergosterol molecule embedded in the phospholipid bilayer of the fungal cell membrane, creating pores on the plasmatic membrane, leading to leakage of cellular components and death. However, recent biophysical studies highlighted that polyenes act like an “ergosterol-sponge,” forming large extramembranous aggregates that extract the essential membrane-lipid ergosterol from the plasma membrane (Robbins et al., 2016). Table 2.1 shows a summary of antifungal drugs and their mechanisms of action and uses. Nystatin is highly toxic and is only available for topical use in the form of cutaneous and/or mucosal creams. Considering it is not absorbed by the gastrointestinal tract, nystatin is also available as an oral suspension to be used as a topical treatment for oral candidiasis. Amphotericin B, on the other hand, is available for systemic use, despite its toxicity, and it is currently the last-line treatment for systemic fungal infections. Lipid, liposomal, and colloidal formulations of amphotericin B have been developed as an attempt to decrease its toxicity, but they are much more expensive than the regular deoxycholate formulation.
Prevention and treatment of burn wound infections: the role of topical antimicrobials
Published in Expert Review of Anti-infective Therapy, 2022
Deepak K. Ozhathil, Steven E. Wolf
Comments: Silver Sulfadiazine is the most well-known and broadly utilized antimicrobial agent for partial and full thickness burns. It was originally introduced in 1968 as Silvadene® by the Marion Corporation, but now is produced by several companies all over the world. It is bactericidal against gram-positive bacteria (Staphylococcus aureus) and gram-negative bacteria (Escherichia coli, Enterobacter, Klebsiella and Pseudomonas species). It has moderate activity against yeast (Candida albicans) and viruses. Its anti-fungal activity is limited, therefore, many formulations add Nystatin to augment its coverage [41]. Isolated reports of resistance with Salmonella, Escherichia coli, Pseudomonas aeruginosa and Klebsiella were have occurred due to resistance genes transmissible via plasmids, but there is no evidence of widespread resistance [1,42]. Silver sulfadiazine is well-tolerated by patients due to its cooling effect. Application is also easy, though can be toxic with oral ingestion and ocular exposure.
Antimicrobial activity of denture adhesive associated with Equisetum giganteum- and Punica granatum-enriched fractions against Candida albicans biofilms on acrylic resin surfaces
Published in Biofouling, 2018
Nara Ligia Martins Almeida, Luiz Leonardo Saldanha, Rafaela Alves da Silva, Karen Henriette Pinke, Eliane Ferraz da Costa, Vinicius Carvalho Porto, Anne Lígia Dokkedal, Vanessa Soares Lara
Although the use of nystatin causes some side effects, such as unpleasant tastes, diarrhea, nausea, vomiting, epigastric pain and the recurrence of inflammation, due to C. albicans resistance (Mansourian et al. 2014), it is important to emphasize the role of nystatin as a conventional antifungal agent for the treatment of fungal infections, including DS. This work does not propose replacing nystatin, but rather to suggest that the addition of herbal medicine extracts with antimicrobial properties, such as E. giganteum and P. granatum or their molecules that are responsible for this action, could maximize the benefits of using denture adhesive in the case of completely removable denture wearers. Moreover, this combination will allow antimicrobial agents to remain close to both the internal surface of the base of the contaminated dental prosthesis and the oral mucosa surface, enabling preventive and therapeutic actions.
Novel polymethyl methacrylate modified with metal methacrylate monomers: biological, physicomechanical, and optical properties
Published in Biofouling, 2022
Georgia Arla Cabrera Khader, Andressa da Silva Barboza, Juliana Silva Ribeiro, Monika Lamas Ferreira, Carlos Enrique Cuevás-Suarez, Evandro Piva, Rafael Guerra Lund
The current treatment of denture-induced stomatitis often involves the use of topical or systemic therapies and, if necessary, repositioning or replacement of the prostheses (Hannah et al. 2017). Antifungals, such as nystatin and fluconazole, are effective in treating the symptoms of infection (Reinhardt et al. 2020). However, due to the long and continuous treatment required for infections, an outbreak of antimicrobial resistance can arise (Rodrigues et al. 2019). This is because many patients do not adhere to treatment due to the costs of medication and its unpleasant taste (Truhlar et al. 1994), and, mainly, due to reinfection of the mucosa through the use of contaminated prostheses (Alrabiah et al. 2019).
Related Knowledge Centers
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