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Anti-fungals (Azoles (FLUCONAZOLE, MICONAZOLE, VORIONAZOLE, POSACONAZOLE,…
Anti-fungals
Azoles
FLUCONAZOLE, MICONAZOLE, VORIONAZOLE, POSACONAZOLE, ISAVUCONAZOLE
ROA - Topical (Miconazole), Systemic oral and parentral (Fluconazole, Vorionazole, Posaconazole, Isavconazole)
MOA - Acts on the fungal cell membrane by inhibiting ergosterol biosynthesis which causes leakage of cellular content
Toxicity - Hepatotoxicity, Interactions with cytochrome P450 and drug metabolism, visual disturbances, hallucinations
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POSACONAZOLE - Prophylaxis against fungal infections in invasive infections. Works against Candida, Aspergillus and Mucorales spp
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Polyenes
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Combinations of drugs used to reduce the side effects. Mainly used for immunocompromised patients such as oncology patients and haematology patients.
AMPHOTERICIN B - Broad spectrum antifungal agent which is active against yeasts, Aspergillus spp, Mucorales spp. It increases the cell permeability and causes leakage of the cell contents. Toxicity- rigors and renal toxicity.
Lipid formulations such as amphotericin B (AmBisome) or amphotericin B lipid complex have fewer side effects
Echinocandins
CASPOFUNGIN, ANIDULAFUNGIN, MICAFUNGIN
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Choice of Agent
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Onychomycosis until the nail grows out- Terbinafine for 6-12 weeks, Itraconazole for 1 week every month for 3 months
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Mycoses
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AMPHOTERICIN B, FLUCYTOSINE- Cryptococcal meningitis
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Prophylaxis
HIV- Anti-candida (FLUCONAZOLE), Anti-PCP (CO-TRIMOXAZOLE, PENTAMIDINE) and long term Fluconazole is given following treatment of cryptococcosis
Haematology, Oncology, Transplantation- Anti-candidate (FLUCONAZOLE) and Anti-aspergillus (POSACONAZOLE)