Infection Disease Management IV
o 22 year old female
o CC: vaginal burning and pruritis, some discharge, patient states she is “feeling very
uncomfortable and cranky”
o HPI: symptoms started 1.5 days ago; patient notes she has just finished an antibiotic Rx
for UTI X 1 week (yesterday) from walk in clinic & that this has happened to her before
after antibiotic Rx.
o PMHx: otherwise healthy
o Meds: 1.Purchased OTC Canestin™ combi pack “1 day therapy” yesterday – product
caused burning and more irritation
2. Septra for UTI X 1 week –finshed yesterday
What else would you like to know?
Many things to ask/get – a few key:
Exam -Visual inspection, swabs
Sexual history UTI symptoms
KT read in Woman’s Health that you can now buy oral medications without a prescription
at the pharmacy for yeast infections
She asks the pharmacists as the topical preparation is very irritating.
The PhC takes a history and recommends Fluconazole 150 mg po X 1 dose for
vulvovaginal candidiasis and recommends she return to clinic in 1 week if symptoms do not
improve. Fungal infections
i. Systemic mycotic infections
- Candidiasis, aspergillosis, cryptococcu(opportunistic, immunocompromised)
- sporotrichosis, blastomycosis, histoplasmosis,(nonopportunistic)
ii. Superficial mycotic infections
- Dermatophytes (tinea = diseases caused by dermatophytes, ringworm, dandruff)
Drugs for Systemic fungal infections
a. Polyene antifungals: conjugated doub**All polyenes are toxic!
1. Amphotericin B: Amphoterrible!
Because it is highly toxic, and only used in fungal infections that are
MOA: binds competitively to ergosterol in the fungal cell membrane; This
increases permeability and leakage of K+, which leads to cell death. It is also
toxic to us, b/c we have sterols in our CM; however, it binds stronger to
ergosterol. (∆we have similar effects) Broad spectrum (not much is resistant)
Poorly absorbed – only IV route used
Lipid based formulations – less toxicity but $$$
Benefit verses harm assessment – reserved for infections that are
aggressive and potentially fatal and not able to be treated by anAzole
Infusion reactions: phlebitis, fever, chills, rigors, nausea, headache,
Nephrotoxicity: InALL patients, damage is related to dose.
Bone marrow suppression: must monitor blood counts to make sure
platelete are good.
Orally not absorbed (not absorbed in stomache)
used for superficial mycosis; dropper liquid for oral thrush
candidal infections- specifically intestinal candidiasis. b. Azole antifungals: have 2 or 3 nitrogens in their five-membered azole ring
Similar spectrum & mechanisms of actions
Don’t see much resistanceanisms causing systemic or deep fungal infections covered
a. Imidazoles: 2 azole rings, tinea type infections/ topical
• Miconazole (topical)
• Clotrimazole (topical) Canestin