What is mycosis ? And how to treat it - fungal infections and DOC 👇

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Infectious diseases caused by fungi called Mycosis….cell wall composed of chitin…Contain Ergosterol

Cutaneous Mycosis/Epidermis= Superficial infection invoving skin …

Anti fungals and fungal infection , pharmacology, kadzung


Drugs for Subcutaneous & Systemic inections

Amphotericin B (Fungicidal/Fungistatic)

From S.nodosus DOC in Systemic mycosis…

MOA

bind to Ergosterol...form pore… Allowing leak of Electrolytes & small molecules…cell death

Antifungal spectrum

 activity against Candida albican, Histoplasma capsulatum,Cryptococcus neoforamans, Coccidicoides immitis, Blastomyces dermatitidis, Apergillus

P.K

 insoluble in water, Deoxycholate added to form colloidal suspension ↓Nephrotoxicity. … 

Liposome formulation AMBISOME, AMPHOTECT, ABELCET…

S.E

 fever & chills, Thrombophlebitis, Nephrotoxicity, Hypotension, normocytic anemia exacerbate in HIV pt receiving Zidovudine

Flucytosine (Fungistatic)

Pyrimidine metabolite.

MOA

5-FC enter via Cytosine permease…

5-FC converted 5-Flourodeoxyuridine 5-monophosphate (5-FDUMP)…Ï´ conversion of dUMP into dTMP….Ï´DNA synthesis

Antifungal spectrum:

 used with Itraconazole to treat Chromoblastomycosis….with Amphotericin B to treat Candidiasis, Cryptococcosis

S.E:

thrombocytopenia, bone-marrow depression, ↑LFT

Ketoconazole (Fungistatic)

First orally active…

Ï´ C-14α-demethylase…block demethylation of Lanosterol to Ergosterol…

Ï´fungal cell growth

Not selective…also inhibit Human gonadal & steroid synthesis…↓Testosterone, cortisol

Antifungal spectrum

not aspergillus activity, 

Itraconazole replaced Ketoconazole…

topical used against Tinea corporis(Trichophyton rubrum), Tinea cruris (T.mentagrophytes), Tinea pedis (E.floccosumm), Tinea versiclor (M.fufur), dandruff

Require Acid for dissolution, Enzyme inhibitor... Teratogenic

S.E:

 Frank hepatitis, Gynecomastia, ↓Libido, Impotence, Menstrual irregularity,↑LFT

Fluconazole

Trizole...devoid of Endocrine side effect…mechanism same to Ketoconazole… DOC in S.neoforman for coccidioidomycosis & candidemias…

S.E

Rashes, teratogenic, ↑LFT

Itraconazole

Broad antifungal spectrum…DOC in Blastommycosis,Sporotrichosis,Histoplasmosis, Paracoccidioidomycosis….require acid for dissolution..

S.E

 Rash,Hypokalemia, Hypertension, edema…not used in pregnancy,CHF

Voriconazole

Used in Invasive Aspergillosis

Echinocandins

Interfere with fungal cell wall by Ï´ β(1,3)-D-glucan leading to cell death….

1.Capsofungin= first in Echinocandin…S.E; Phlebitis, Flushing due to Histamine release...

2. Micafunngin & Anidulafungin= no dose adjustment in renal impair

Drugs for Cutaneous Mycotic infections

Mold-like fungal infection that cause cutaneous infection are called Dermatophytes/Tinea

Tinea pedis infection of feet, refered as “Ringworm”

Squalene epoxidase inhibitor:

a) Terbinafine=Ï´Squalene epoxidase, ↓Ergosterol synthesis…accumulation of toxic Squalene, cell death

1%Cream & solution used for Tinea pedis, Tinea cruris, Tinea corporis

S.E= Taste & visual disturbancee, Hepatotoxicity, Neutropenia

Griseofulvin (Fungistatic) 

Accumulate in Keratin tissue...disruption of Mitotic spindle… inhibition of fungal mitosis….

Abs ↑by fatty meal…

used in nail,skin infection

Nystatin= only topical...oral “Swish & Spit”

Imidazole= Miconazole potent inhibitor of Warfarin


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