Scribd Logo
Upload

Welcome to Scribd!

  • 179 views

    Anti-Fungal Drugs Sush

    Uploaded by

    Cheng Xinvenn
    This document discusses antifungal drugs, their mechanisms of action, and their importance for treating fungal infections in diabetic patients. It classifies antifungals based on how they work, such as polyene antibiotics that disrupt fungal cell membranes or azoles that inhibit ergosterol synthesis. Common fungal infections in diabetics like athlete's foot and thrush are described. Guidelines for treating superficial versus systemic fungal infections with topical or oral antifungals like nystatin, fluconazole, and griseofulvin are provided. Factors predisposing diabetics to fungal infections and principles of antifungal treatment are also summarized.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd

    Anti-Fungal Drugs Sush

    Uploaded by

    Cheng Xinvenn
    179 views31 pages
    This document discusses antifungal drugs, their mechanisms of action, and their importance for treating fungal infections in diabetic patients. It classifies antifungals based on how they work, such as polyene antibiotics that disrupt fungal cell membranes or azoles that inhibit ergosterol synthesis. Common fungal infections in diabetics like athlete's foot and thrush are described. Guidelines for treating superficial versus systemic fungal infections with topical or oral antifungals like nystatin, fluconazole, and griseofulvin are provided. Factors predisposing diabetics to fungal infections and principles of antifungal treatment are also summarized.

    Original Description:

    anti fungal

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses antifungal drugs, their mechanisms of action, and their importance for treating fungal infections in diabetic patients. It classifies antifungals based on how they work, such as polyene antibiotics that disrupt fungal cell membranes or azoles that inhibit ergosterol synthesis. Common fungal infections in diabetics like athlete's foot and thrush are described. Guidelines for treating superficial versus systemic fungal infections with topical or oral antifungals like nystatin, fluconazole, and griseofulvin are provided. Factors predisposing diabetics to fungal infections and principles of antifungal treatment are also summarized.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    179 views31 pages

    Anti-Fungal Drugs Sush

    Uploaded by

    Cheng Xinvenn
    This document discusses antifungal drugs, their mechanisms of action, and their importance for treating fungal infections in diabetic patients. It classifies antifungals based on how they work, such as polyene antibiotics that disrupt fungal cell membranes or azoles that inhibit ergosterol synthesis. Common fungal infections in diabetics like athlete's foot and thrush are described. Guidelines for treating superficial versus systemic fungal infections with topical or oral antifungals like nystatin, fluconazole, and griseofulvin are provided. Factors predisposing diabetics to fungal infections and principles of antifungal treatment are also summarized.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    You are on page 1of 31

    Anti-Fungal drugs

    Dr Sushela Devi
    Classify the different antifungals based on their mechanisms of action Describe the mechanism of action of antifungals Relate the importance of antifungals to diabetic patients Summarise the principles of antifungal treatment

    Relevance of antifungals in diabetes


    Immunologic research has demonstrated several defects in host immune defense mechanisms in diabetic subjects. Several PMN defects occur in diabetic subjects: impaired migration, phagocytosis intracellular killing anatomically specific factors may contribute to an increased infection risk. Examples Macrovascular disease and microvascular dysfunction may result in compromised local circulation leading to delayed response to infection Unawareness of lower extremity trauma due to sensory neuropathy may result in inadequate attention to minor wounds and subsequent increased infection Incomplete bladder emptying due to autonomic neuropathy permits urinary colonization by microorganisms

    Infections in diabetic patients


    Genitourinary infections Foot and lower extremity infections Respiratory infections-diabetics are more likely to be hospitalised for pneumonia than non-diabetics A higher risk for TB Group B streptococcal infections Fungal infections

    Fungal infections
    Athletes foot Jock itch Onychomycosis (nail infections) Thrush Pityriasis versicolor- This fungal infection causes light skinned people to have dark spots on their skin. Dark skinned individuals will find light patches on their skin. Mucormycosis- frequently involves the sinuses, the brain and the lungs. If left untreated can be life threatening.

    Classification of antifungals based on their mechanism of action


    Agent Polyene antibiotics Azoles Terbinafine
    Mechanism of action Disruption of fungal cell membrane

    Griseofulvin

    Inhibition of mitosis Inhibition of DNA synthesis

    Flucytosine

    Polyene antibioitics
    Nystatin- no injectable formulations of the drug. It may be used orally or topically due to its minimal absorption across the mucous membranes
    Amphotericin B-antifungal and an anti-protozoan. Can be used to treat visceral leishmaniasis.

    Azoles Antifungal: Antibacterial: Antiprotozoal: Anthelminthic

    Antifungal azoles
    Imidazoles Ketoconazole Miconozole Clotrimazole Triazoles Fluconozole Itraconazole

    Fungal infections Superfical fungal infections Affects the skin and mucous membranes Systemic fungal infections Affects deeper tissues eg. heart, brain

    Drugs for superficial fungal infections Nystatin Amphotericin Azoles Terbinafine Griseofulvin

    Topical antifungal drugs/medicines Nystatin


    Only for candidiasis Only for topical use Skin Mouth and intestines Vaginal candidiasis

    Amphotericin: new topical preparations available

    Azoles

    Topical antifungal drugs/medicines

    For dermatophytes-microspora, ep-dermophyton, trichophyton (Tinea/ringworm) Tinea versicolor Candidiasis--- 7 taginal typesvaginal thrust

    Topical antifungal drugs Whitfields ointment for dermatophytes

    Composition Salicylic acid 3% Benzoic acid 6% Emulsifying ointment 91%

    Case history
    55-year old male diabetic with nosocomial urinary tract infection was treated with antibiotics. He presented with severe throat pain a week after treatment.Reflect on what you would do in this case?---oral thrust

    Mechanism of action: polyene antibiotics

    The drug binds to ergosterol, specific to fungal membranes, and changes the membrane permeability, ----form spores in ergpdterol ,this leads to leakage of ions and enzymes from fungal cells Causes cell death of fungi

    Ergosterol is not found in mamalian cell membranes

    Topical antifungal drugs:


    Nystatin
    Preparations (dosage forms)
    Mouth washes Mouth paints Oral tablets/lozenges Creams Vaginal pessaries

    Side effects
    Nausea Vomiting Diarrhoea Severe skin rashes

    Amphotericin: lozenges

    Mild gastrointestinal disturbances

    Fungal infections: dermatophytes (ringworm, tinea)


    Tinea coporis---on body Tinea capitison scalp Tinea pedis (athletes foot) Tinea unguiumfinger/hand

    scalp

    On UV light, shiny scalp with ringworm

    Athlete foot

    Topical antifungal drugs:Azoles Preparations


    Creams Ointments Dusting powders Shampoos

    Mechanism of action:Azoles Interferes with fungal oxidative enzymes causing lethal accumulation of hydrogen peroxide,also Reduced formation of ergosterol (nescessary for the formation of the fungal wall) Damage the fungal membrane by inhibiting a demethylase enzyme.responsible for formation of ergosterol

    Drugs for systemic fungal infections


    Amphotericin B Ketoconazole Fluconozole(for Candida albicans)prevent resistance Itraconazole Voriconazole (broad spectrum) Flucytosine (often given in combination with amphotericin B)

    Amphotericin B
    The drug of choice for most systemic fungal infections Has many side effects Fever, chills Anorexia, nausea, vomiting Renal impairment Hypokalaemia The toxic effects may have to be identified and treated in life threatening infections. Lipid formulations less toxic (expensive)

    Ketoconazole
    Metabolised in the liver, excreted in the bile Azoles are toxic to liver It is a hepatic microsomal enzyme inhibitor, Inhibits metabolism of warfarin, phenytoin sodium and cyclosporin Causes above drug toxicity if given concurrently Oral preparation should not be used for superficial fungal infections Oral form is contraindicated in pregnancy & breast feeding

    Fluconozole Well absorbed after oral administration Good penetration into CSF Effective in fungal meningitis (IV)caused by streptococcus neoformans, capsulated yeast Hepatotoxicity is less

    Improved absorption with food, reduced absorption with fatty meals Risk of Liver damage Caution in heart failure with prolonged use or IV use Griseofulvin:mechanism of actiontreat ringworm, x kill fungi Dermatophytes specifically infect keratinous tissues Griseofulvin binds to keratin as it is being formed in the cells of the nail bed, hair follicles and skin Prevents infection of new keratin Does not kill already established fungi

    Itraconazole

    Causes liver enzyme induction Contraindicated in pregnancy avoid pregnancy for one month after treatment. Men should not father children within 6months of treatment Prolonged treatment is necessary until infected keratin is shed.

    Griseofulvin
    Given orally better absorbed with fatty food Only effective dosage form is oral tablets

    Terbinafine

    A New drug for superficial dermatophyte infections Dosage forms: 1. Topical preparations 2. Oral tablets Side effects: liver toxicity, Skin rashes, blood dyscrasias

    Griseofulvin and Terbinafine


    Effective only for superficial dermatophyte infections

    Not effective in
    Superficial candidiasis Tinea versicolor Systemic fungal infections

    Factors predisposing to fungal infections


    Diabetes mellitus Use of broad spectrum antibiotics, cytotoxics (anti cancer drugs) Immune deficiency-congenital, acquired, drug induced (steroids), due to malignancy Repeated trauma,foreign bodies, IV lines Prolonged immersion in water Infancy, old age, pregnancy

    Principles of antifungal treatment


    Drugs used depend on the type of infection Superficial? or deep? If superficial infection: topical therapy sufficient or oral therapy is required? Do not use oral drugs for trivial (minor) infections Look for risk factors and correct

    Principles of antifungal treatment ctd..

    Look for an animal source for dermatophyte infections Toxicity is less with topical azoles Azoles are toxic to liver when given orally, monitor liver functions Prolonged treatment is necessary for infections affecting the stratum corneum. Most systemic antifungals; caution in prgnancy. Avoid, unless benefit outweighs the risks

    Thank you for listening Hope you enjoyed the lecture

    You might also like

    pFad - Phonifier reborn

    Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

    Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


    Alternative Proxies:

    Alternative Proxy

    pFad Proxy

    pFad v3 Proxy

    pFad v4 Proxy