Drug Therapy for Fungal Infections

Candidiasis

Infection either containing or caused by Candida fungi

Dermatophytes

Fungal parasite that grows in or on the skin

Fungi

Plantlike organisms that live as parasites on living tissue or as saprophytes on decaying organic matter

Immunocompromised

Having an impaired or weakened immune system

Molds

Fungi that are widely dispersed in the environment and either saprophytic or parasitic; multicellular organisms composed of colonies of tangled strands

Mycoses

Disease induced by a fungus or resembling such a disease

Yeasts

Unicellular fungi of the genus Saccharomyces or Candida

Fungistatic Drugs

Those that inhibit growth

Fungicidal Drugs

Kills fungal pathogens

Characteristic of Fungal Infections

Fungal infections may be mild and superficial or life threatening and systemic, mainly in immunosuppressed hosts. Fungi are larger and more complex than bacteria. Thick, rigid, cell wall

What is the prototype for Polyenes?

Amphotericin B

What is the prototype for Azoles?

Fluconazole

What is the prototype for Echinocandins?

Caspofungin

What is the prototype for Pyrimidine Analog?

Flucytosine

What is the use for Polyenes?

Serious, systemic fungal infections. Candidiasis

What is the use for Azoles?

Prevention of candidiasis after bone marrow transplant, candidiasis, cryptococcal meningitis

What is the use for Echinocandins?

Invasive aspergillosis and candidiasis

What is the use for Pyrimidine Analog?

Serious infections caused by candida and cryptococcus

Amphotericin B

High alert medication due to its ability to cause organ failure, respiratory arrest, MI, arrhythmias, and electrolyte imbalances. Patient needs to be on tele. Only used for intense, progressive, fatal infections.

What are the administration specifics for Amphotericin B?

Needs to be given with a special IV filter. Needs to be mixed with D5. Must run over 2-6 hours and cannot be given piggy back. Must be hung 8 hours after it is sent by the pharamacy.

Nystatin

Same action as Amphotericin B. Not absorbed systemically, so referred to as “Nice-statin”. Swish and swallow

Azole Drugs (Fluconazole)

Kills systemic fungus. ZOLE-Q:

Z- Many drug interactions (no warfarin, no losartan)

O- Observe hygiene measures

L- Liver Function Tests

E- Educate to take with food

Q- QT Elongation

Echinocandin Drugs (Caspofungin)

Aspergillosis is the most common use, very aggressive. Cannot administer mannitol while patient is on this drug. Cannot mix with dextrose. Must be given at room temperature and given over an hour

Pyrimidine Analog (Flucytosine)

Works with amphotericin B. Cannot be used in pregnant patients. Need to use extreme caution in patients with renal impairment.