Superficial Fungal Infections (Elder)

What fungus accounts for 85-90% of symptomatic episodes of VVC

C. albicans

VVC Sexual Considerations

• NOT a sexually transmitted infections

• Do NOT treat asymptomatic partners

VVC Presentation

• Vulvar itching (60-90% of cases)

• Curdy cheese-like discharge

Uncomplicated VVC

• Sporadic (< 3 episodes/year)

• Mild-moderate symptoms

• Typically caused by Candida albicans

• Occurs in healthy, non-pregnant women

Complicated VVC

• Severe and/or recurrent (≥ 3 episodes/year)

• Poor response to short-course therapy

• May be antifungal resistant

• Associated with comorbidities

  • Pregnancy

  • Immunodeficiency

  • Diabetes

Is treatment of asymptomatic candida colonization recommended

NOT recommended

Uncomplicated VVC Treatment

1^st Line

• Fluconazole 150mg PO once
  OR

• Topical azoles 1-7 days

Is Fluconazole or topical azole preferred in pregnancy

Topical

Complicated VVC Treatment

• Fluconazole 150mg every 72 hours for 2-3 doses

• Pregnancy → topical azole only

Recurrent VVC Treatment

1. Induction therapy to achieve remission

2. Maintenance (suppressive therapy)

Anti-fungal resistant VVC persistant despite previous treatment

Boric acid 600mg vaginally QD x 3 weeks

Uncomplicated Oropharyngeal Candidiasis standard treatment

• Nystatin (7-14 days)

• Clotrimazole (7-14 days)

Oropharyngeal Candidiasis Clotrimazole Treatment

Clotrimazole 10mg troche

• Hold 1 troche in mouth for 15-20 mins 5x a day

Side Effects

• Altered taste

• N/V

Oropharyngeal Candidiasis Nystatin Treatment

Nystatin 100,000 units/mL suspension

• 5mL swish and swallow 4x daily

Side Effects

• N/V/D

Duration of therapy for Fluconazole-Refractory Oropharyngeal Candidiasis

14-21 days

Esophageal Candidiasis Treatment

1^st Line

• Fluconazole 400mg PO loading dose → 200-400mg PO QD x 14-21 days

Tinea pedis (Athletes’s foot) treatment

Topical antifungal therapy for 2-4 weeks

• 1^st Line: Terbinafine 1% QD

  • Continue therapy 1 week after clinical resolution

Tinea Cruris (Jock’s itch) Treatment

Topical therapy for 1-2 weeks FOLLOWING symptom resolution

• 1^st Line: Terbinafine 1% QD

Tinea Capitis Treatment

Oral Terbinafine and cleaning of combs and brushes

• 1^st Line: Terbinafine 250mg QD x 4-6 weeks

  • Griseofulvin 500-1000mg QD x 6-8 weeks

Onychomycosis Treatment

Systemic therapy more effective

• 1^st Line: Terbinafine 250mg QD (highest cure rate)

  • 6 week course for fingernails

  • 12 week course for toenails