ANTIFUNGALS
Fungal infections are among the most common causes of skin diseases. Most localized fungal infections are treated with topical preparations. Systemic therapy is necessary for nail or scalp infection or if the skin infection is wide spread, disseminated or intractable.
Dermatophytosis - Ring worm infection can affect the scalp by Tinea capitis, body by Tinea corporis, groin by Tinea cruris, hand by Tinea manuum, foot by Tinea pedisand nail by Tinea unguinum. Scalp infection requires systemic treatment. Most local ringworm infections can be treated adequately with topical antifungal preparations.Tinea infection of the nail is almost always treated systemically.
Pityriasis Versicolor-Pitryasis versicolor may be treated topically with a course of selenium sulfide. Topical imidazole antifungals and topical terbinafine are alternatives but large quantities may be required. If topical application fails, or if the infection is wide spread, Pitryasis vesicolor is treated systemically with an azole antifungal.
Candidiasis - Candidal skin infections may be treated with topical application of theimidazole antifungals . Topical application of nystatin is also effective for candidiasis.
Compound topical preparations:
Combination of an imidazole and a weak corticosteroid may be of value in the treatment of eczematous intertrigo and a severely inflammed patch of ringworm. The combination of nystatin and a weak corticosteroid may be of use in the treatment of intertrigo associated with Candida.
Choices of anti-fungal formulation-Lotions or sprays are suitable for application to large and hairy areas. Ointments are generally used on dry areas. Creams are suitable for moist areas.
Ketoconazole is a synthetic imidazole derivative with fungistatic activity against dermatophytes, yeasts and other pathogenic fungi. It acts by inhibiting the synthesis of ergosterol, an essential component of the surface membrane of fungal cells.
Indications: dermatophyte infection of the skin, candidiasis, pityriasis versicolor, seborrhoeic dermatitis
Cautions: liver functions should be assessed before and at a monthly interval throughout treatment. Treatment should be withdrawn immediately if there is evidence of hepatocellular damage
Contraindications: hypersensitivity to azole derivatives, CHILD under 2 years, and impaired hepatic function
Interactions: see Appendix-2
Side-effects: nausea, vomiting, abdominal pain and increase in hepatic enzymes, hypersensitivity reactions and thrombocytopenia (rare)
Dose: 2-6 mg per kg daily for 4 – 6 weeks.
Proprietary Preparations
Ketofun(Amico),Tab. 200mg, Tk. 8.33/Tab.
Ketocon (Opsonin), Jab. 200mg, Tk. 8/Tab.
Ketoral (Square), Tab. 200mg, Tab. 9/Tab.
It is a triazole derivative with broad spectrum activity. It is the most popular oral agent and has the greatest activity against Candida albicans
Indications: candidiasis, dermatophytosis
Cautions: liver functions should be monitored in hepatic impairment
Contraindications: Pregnancy and breast-feeding
Side-effects: fluconazole is generally well tolerated. Nausea is the most frequently observed side-effect. Vomiting and gastrointestinal discomfort have also been reported. Hepatic enzymes may also be raised.
Interactions: see Appendix 2
Dose: ADULT 50 mg daily for 2-6 weeks in different fungal infections . CHILD 3-6 mg per kg body weight daily for 2- 4 weeks. For vaginal candidiasis and candidal balanitis: a single dose of 150 mg is sufficient
Proprietary Preparations
Anfasil (Silva), Cap. 150mg, Tk. 20/Cap.;50mg, Tk.7/Cap.; Susp. 1g, Tk. 75/35ml
Canazole (ACI), Powder For Susp. 50mg/5ml,Tk.78/35ml; Tab. 150mg, Tk. 20/Tab.; 50mg,Tk. 7/Tab.
Candinil (Healthcare), Cap. 50mg, Tk. 8/Cap.;Cap. 150mg, Tk. 22/Cap.
Conaz (Orion), Cap. 150mg, Tk. 12/Cap.;50mg, Tk. 5/Cap.
Diflu(Aristopharma), Cap. 150mg, Tk. 18/Cap.;5Omg, Tk. 7/Cap.; Powder For Susp. 50mg/5ml,Tk. 75/35ml
Diflucon (Aexim), Cap. SOmg, Tk. 5/Cap.
Mucon (Opsonin), Cap,150mg, Tk. 10/Cap.;5Omg, Tk. 7/Cap.; Susp. 50mg/5ml,Tk.70/35ml
Fluconal (Acme), Susp. 50mg/5ml,Tk.61/35ml; Tab. 150mg, Tk.13.50/Tab.;5Omg, Tk. 5/Tab.
Flucostan (Ziska), Cap. 5Omg, Tk. 8/Cap.
Flucostin (United Chem), Tab. 150mg, Tk.13.50/Tab.; 5Omg, Tk. 5/Tab.
Flugal (Square), Cap. 150mg, Tk. 22/Cap.;5Omg, Tk. 8/Cap.; Susp. 50mg/5ml, Tk.78/35ml
Ftunac (Drug Intl), Tab. SOmg, Tk. 5/Tab.;
Silcona (Silco), Cap. 50mg, Tk. 7.50/Cap.
Zolen (Apex), Cap. 150mg, Tk. 18/Cap; Cap.150mg, Tk. 5/Cap.
Indications; Side-effects; and Contraindications: see under ketoconazole .
Proprietary Preparations
Afun (Square), Cream, 1%, Tk. 25/1Og
Cantrim (Rephco), Cream, 1%, Tk. 28/1Og ,
Clodal (Globe Pharma), Cream,1%,Tk.25/10g.
Cloderm (General),Cream, 1%, Tk. 32/1Og
Clotrim (Acme),Cream, 1%, Tk. 28.50/10g ;Tk 18.25/5 g
Clotrizole (Reman), Cream, 1%,Tk.22.75/10g,
Zenesten (Doctors), Cream, 1%, Tk.31/20 g,
Clotrimazole 1% + Hydrocortisone 1%
H-Trimazole (Opsonin), Cream, Tk. 35.50/1Og,
Neosten HC (Beximco), Cream, Tk.35/10g, Tk. 55/20g
Indications; Side-effects; and Contraindications: see under Ketoconazole .
Proprietary Preparations
Conazole (Aristopharma), Cream, 1%, Tk. 28.40/1Og
Ecoderm (Rephco),Cream, 1%, TK. 28/1Og
Econal (Chemico), Cream, 1%, TK.32/10g
Econate (Incepta), Cream, 1%, TK. 28/1Og
Econate-G (Incepta), Cream, 1%, TK. 70/30g
Ecozole (Opsonin), Cream, 1%, TK. 70/30g
Econazole 1%+Triamcinolone 1%
Diconater (Drug Intl), Cream, Tk. 35/1Og
Ecoderm T.A (Rephco),Cream, Tk. 31.80/1Og
Econate Plus (Incepta), Cream, Tk. 34/1Og
Ecotrim (Beximco),Cream,Tk. 34.50/1Og
Tinacort (Chemico),Cream, Tk. 34/1 Og
Tricoderma (General), Cream, Tk. 31.80/1 Og
MICONAZOLE NITRATE
Indications; Side-effects; and Contraindications: see under ketoconazole .
Proprietary Preparations
Fungidal (Square), Cream 2%, Tk. 35/1Og
Fungidal HC(Square),Cream.Tk. 40/Tube
Gemison (General), Cream,Tk. 40/Tube
G-Miconazole (Gonoshasthaya), Cream, 2%, Tk.18.21/5g, Tk.34.39/10g
Mic (Globe Pharma), Cream, 2% Tk. 35/1Og
Mic-HC (Globe Pharma), Cream, Tk. 37/1Og
Miconazole 1% with Hvdrocortisone 2%
Miconex (ACI), Cream 2%; Tk. 35/1Og
Miconil (Nipa), Cream, Tk. 40/1Og
Micosone (ACI), Cream, Tk. 37/1Og; Oint.Tk.37/10g
Micozole (Gaco), Cream, 2%, Tk.30/10g
Micozole -HC (Gaco), Cream, 2%, Tk. 38/1Og
Indications; Side-effects; and Contraindications: see section 6.2.2
Proprietary Preparations
Nystat (Acme), Oint. 1,00,000 unit; Tk. 20.23/1 Og
Nvstalin 10,000 units, Neomvcin Sulphae 2.5mg. Gramcidine 0.25mg,Triamcinolone Acelonide 1mo/g:
Fungistat (Drug Intl), Oint. Tk.18.90 /5g
Ganacomb (Gaco), Cream. Tk.18.80/5g
Monacom (Amico), Cream, Tk. 29.67/5g
GRISEOFULVIN (ED)
Griseofulvin is an antibiotic of fungistatic action. It is no longer a drug of choice for onychomycosis
Indications: superficial fungal infections . Because of its safety profile and high efficacy, griseofulvin remains the drug of choice for children of Tinea capitis
Cautions: it should be taken preferably with meals
Interactions: see Appendix- 2
Contraindications: known hypersensitivity to griseofulvin , pregnancy, SLE, severe hepatic impairment
Side-effects: it includes gastrointestinal upsets, headache and photosensitivity
Dose: micronized 15-20 mg per kg per day orally for 4-6 weeks or 500mg daily single or divided dose
Proprietary Preparations
Afuvin (Ambee), Tab. 5OOmg, Tk. 5.30/Tab.
Fulcinex (ACI), Suspn.125mg/5ml, Tk.23.33/60ml; Tab. 5OOmg, Tk.5.56/Tab
Fulvisin (Standard), Tab. 500mg,Tk.6.83/Tab.
G.Gvin (Gonoshasthaya),Jab. 5OOmg,Tk.4/Tab.
Griseofulvin (Chemist), Tab.5OOmg,Tk.5.06/Tab.
Griso (Ziska). Tab. 5OOmg, Tk.2.50/Tab,
Grisofulvin-M (Modem), Tab., 5OOmg,Tk.5.56/Tab.
Grisovin FP (GSK), Tab. 5OOmg, Tk.5.56/Tab.
Grisozen (Zenith), Tab. 5OOmg, Tk.S/Tab
Grovin (Nipa),Tab. 5OOmg, Tk.5.56/Tab.
J-Fulvin ( (Jams),Tab. 5OOmg, Tk.4/Tab.,
Refulvin (Rephco),Tab. 5OOmg, Tk.S/Tab
Seovin (Chemico),Tab. 5OOmg, Tk.S/Tab.
Itraconazole is a broad-spectrum triazole that has been found to be effective in the treatment of various superficial fungal infections . It is less effective in treating dermatophyte infection of nails than terbinafine but more effective than terbinafine in treating candidiasis. It has been used successfully in patients with fluconazoleresistant disease.
Indications: dermatophytosis and candidiasis.
Cautions: liver transaminases should be monitored before treatment and periodically throughout treatment if the treatment lasts for more than 4 weeks.
Interactions: see Appendix-2 .
Contraindications: Known hypersensitivity to azole derivatives. Severe hepatic impairment.
Side-effects: it is preferable to ketoconazole due to lower side effects and less drug interactions, hepatotoxicity .
Dose: 200 mg orally a day for a variable duration in different fungal infections .
Proprietary Preparation
Itra (Square), Cap.100mg, Tk. 25/Cap. ltracon (Navana), Cap.100mg, Tk. 20/Cap.
Terbinafine is an allylamine that has boon found to be effective in the treatment of superficial fungal infections .
It is less effective in treating candidiasis than azole derivatives. It is largely metabolized in the liver.
Indications: Superficial fungal infections , candidiasis and onychomycosis.
Cautions: if therapy continues for more than six weeks, transaminases should be monitored.
Contraindications: known hypersensitivity to terbinafine , severe liver disease.
Interactions: see Appendix-2 .
Side-effects: nausea and headache are common. Hepatotoxicity and pancytopenia may occur.
Dose: for Tinea versicolor: 250 mg orally a day for 5 days; Tinea corporis, cruris and pedis: 250 mg orally a day for 2-4 weeks per kg. Onychomycoses: 250 mg orally a day for 6-12 weeks.
Proprietary Preparations
Derbicil (Incepta), Cream, 1%, Tk. 50/5g
Infud (General), Tab. 250mg Tk. 50/Tab.;Cream, 1%, Tk. 30/5g
Mycofin (Eskayef), Tab. 250mg, Tk. 50/Tab.;Cream, 1%, Tk. 50/1 Og
Skinabin (ACI), Cream, 1%, 15g, Tk. 50/15g;Tab. 250mg, Tk. 40/Tab.
Telfin (Unimed &unihealth). Cream, 1%, Tk.50/5g,
Terbex (Beximcd)Jab. 250mg, Tk. 50/Tab.;Cream, 1%, Tk. 35/5g
Terbifin (Aristopharma),Tab. 250 mg,Tk.30/Tab; Cream, 1%, Tk. 35/10g
Terbin (Opsonin), Cream, 10mg/g, Tk. 30/5g,
Xfin (Square), Cream, 1%, Tk. 50/5g,
Indications: fungal nail infection
Cautions: avoid contact with eyes and mucous membrane.
Contraindications: pregnancy
Interactions: see Appendix-2 .
Side-effects: Occasional local irritation, local oedema, dry skin, nail discoloration; periungual inflammation; nail pain; rash; exfoliation.
Dose: apply to nails and surrounding skin twice daily for up to 6 months (may be extended to 12 months)
Proprietary Preparation
Conasyd (Renata),1%, Cream, Tk.47.54/10g
WHITFIELD’S OINTMENT (Compound Benzoic Acid)
It is a combination of benzoic acid which has fungistatic action and salicylic acidwhich has keratolytic action.
Indications: superficial fungal infections , pityriasis versicolor.
Cautions: This should not come in contact with eyes.
Contraindications: Known hypersensitivity to any component of Whitfield’s ointment.
Interactions: see Appendix-2 .
Side-effects: mild inflammatory lesions.
Administration: a thin layer of ointment or cream should be applied twice daily to the affected area for at least 4 weeks.
Proprietary Preparations
Ointments containing Benzoic acid 6% and Salicylic acid 3%:
Bensal (Gaco),Jk. 5.54/10g ;Tk. 9.35/30g
Salben (Opsonin), Tk 13/25g
White Guard (Mil/at), Tk. 10/12g
Whitfield (Asiatic), Oint. Tk. 9.7/30g
Whitfield (Cipla).Oint. Tk.12/15g; Tk. 9.82/30g
Whitfield (Modem), Tk.11/25g; Tk.8/15g
Indications: teniasis, onychomycosis
Proprietary Preparations
Tinafate (Pharmadesh), Cream 1% Tk.25/10g
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