Fungi

PRIMARY INFECTION
RX
Disp:
Sig:
Zovirax Capsules 200mg
#50
1 cap q4h while awake for
a total of 5 caps daily for
10 days
RECURRENT INFECTION
RX
Disp:
Sig:
Zovirax Capsules 200mg
#25
1 cap q4h while awake for
a total of 5 caps daily for 5
days
PREVENTION
RX
Disp:
Sig:
Zovirax Capsules 200mg
#100
1 cap tid
Start 3 days before
triggering event
ZOVIRAX OINTMENT
MANY CLAIM PREVENTION
OF RECURRENT LESIONS IF
APPLIED AT PRODROME
1
Docosanol (Abreva ®) is a compound with a unique
mechanism of action involving viral fusion inhibition.
In randomised clinical trials, a 10% docosanol cream
formulation, initiated within 12 h of symptoms onset,
demonstrated efficacy in reduction of time-to-healing
compared with a polyethylene glycol control. Despite its
potential to be a mild irritant, this novel antiviral was
well-tolerated in clinical trials. Docosanol is the first
topical antiviral approved for over-the-counter use in
recurrent herpes labialis.
Testimonial
Abreva®
Docosanol cream 10%
“Reduces initial size of cold sore
and speeds healing time.
Works better each
subsequent time.”
Expert Opin Pharmacother. 2004 Dec;5(12):2567-71.
Leung DT, Sacks SL.
Denavir® (penciclovir)
Cream
For recurrent herpes labialis. Claims to
heal in 4 1/2 days (used every 2 hours) and
reduces pain by 1/2 day.
Healed 31% faster than placebo group
May prevent lesion if used at prodrome.
2
Non-specific gingival ulceration
that has a “horizontal”
component
Toothbrush trauma should
be your first thought
COLD SORES vs. CANKER SORES
LIP
FIXED MUCOSA
VESICULAR
INTRAORAL
MOBILE MUCOSA
CRATERIFORM
1st Midterm Exam
Friday, 8 February
8:00 am!
Everything included
through Today’s class
3
•Questions from clinical slides
•Multiple choice including matching,
true and false
•Fill-in and short answer
(spelling counts)
•Beware of EXCEPT type multiple
choice questions
•Watch the time
•THINK
CANDIDIASIS
4
5 Ds of Candidiasis
• Drugs
• Dentures
• Diabetes
• Debilitation
• dryness
5
Treatment for
candidiasis
• Diflucan (fluconazole)
• Nizoral (ketoconazole)
• Topical
– Vaginal tablets (hard to find)
– Cariogenic
• Mycelex (Clotrimazole) troches
• Nystatin suspension
NIZORAL (KETOCONAZOLE)
1st systemic antifungal
•Main side effect - liver damage
•Needs acid environment
•Can interact with several drugs and cause
cardiac arrhythmias
•Not recommended for first treatment for
oral candidiasis at this time because of
possiblity of liver damage
6
DIFLUCAN (FLUCONAZOLE)
•1 time per day
•Acid environment not necessary
•Expensive
•Effective
•Candidiasis, Cryptococcal meningitis
•Interacts with Dilantin, warfarin
anticoagulants, and oral hypoglycemics
If anti-fungal therapy fails to
produce complete resolution,
then the remaining abnormal
tissue should be biopsied to
rule out premalignant change
or malignancy.
Allen, C.M.
JADA 123:77-82, 1982
TREATMENT OF
DENTURE CANDIDIASIS
• Underlying cause (5 Ds
besides dentures)
• Change denture habit
• Disinfect denture
• Anti-fungal
7
TREATMENT FOR
ANGULAR CHEILITIS
Rx: Nystatin CREAM
DISP: 15 gm tube
SIG:
Apply to corners of
mouth qid
Other treatments for
angular cheilitis that
contain corticosteroids
• Vytone
– Cream - iodoquinol 1% and
hydrocortisone 1%
• Mycolog II
– Nystatin and triamcinalone 0.1%
Angular cheilitis
• In children usually caused by
staphylococcus
• In adults if it does not clear quickly
with anti-fungal
TREAT WITH OTC
“TRIPLE ANTIBIOTIC OINTMENT”
Histoplasmosis
•Most common systemic fungal disease
in the U.S.
•Histoplasma capsulatum - dimorphic
–Yeast at body temperature
–Mold in the environment
•Most cases asymptomatic
8
Histoplasmosis
•Expression of disease depends on
–Amount of spores inhaled
–Immune status of the host
9