Antifungal Agents ; administration & dosage ; Biomedical Research ; Drug Delivery Systems ; Humans

No abstract available.
Anti-Bacterial Agents/*administration & dosage ; Antibiotic Prophylaxis/*standards ; Antifungal Agents/*administration & dosage ; Fever/*drug therapy ; Humans ; Neutropenia/*drug therapy

Human ; Male ; Adolescent ; Antifungal Agents ; Double-blind Method ; Drug Administration Schedule ; Itraconazole ; Tinea Versicolor

INTRODUCTIONInflammatory tinea capitis is an uncommon condition in Singapore. In this case report we present a patient whom we managed for this condition.

CLINICAL PICTUREA 4-year-old girl presented to us with multiple pustules over the occipital scalp for 6 weeks, associated with painful cervical lymphadenopathy. Her condition did not respond to topical and oral antibiotics.

TREATMENTThe patient was diagnosed with kerion (inflammatory tinea capitis) and fungal culture of plucked hairs from the kerion grew Microsporum species of dermatophyte. She was treated with a course of oral griseofulvin and topical selenium sulfide shampoo. She was advised to bring her pet cats to the veterinarian for screening, as well as not to share combs with her other siblings.

OUTCOMEHer condition improved with the antifungal therapy, and there was no residual alopecia.

CONCLUSIONPhysicians should consider tinea capitis when they encounter a patient with scalp folliculitis or scarring alopecia in the appropriate clinical context.

Administration, Oral ; Administration, Topical ; Antifungal Agents ; administration & dosage ; Child, Preschool ; Female ; Griseofulvin ; administration & dosage ; Humans ; Microsporum ; isolation & purification ; Selenium Compounds ; administration & dosage ; Tinea Capitis ; drug therapy ; microbiology

Vulvo-vaginal candidiasis (VVC) is a common infection among women. 5% of women with acute infection experience recurrent vulvo-vaginal candidiasis (RVVC). There is currently no optimal or recommended regime for RVVC. Although antifungal agents, such as imidazoles, have been successfully used as a first-line treatment for acute VVC, its effectiveness is limited in RVVC. This could be due to patient factors, drug application (such as leakage) or dosing factors. A sustained-release (SR) bioadhesive vaginal cream (2% butoconazole nitrate) has incorporated VagiSite technology, a topical drug delivery system that allows SR of the drug. We describe its efficacy and the successful use of a butoconazole-SR formulation in the treatment of two cases of RVVC.
Adult ; Antifungal Agents ; administration & dosage ; Candidiasis, Vulvovaginal ; drug therapy ; Female ; Humans ; Imidazoles ; administration & dosage ; Middle Aged ; Pessaries ; Recurrence

OBJECTIVETo evaluate the incidence of Ketoconazole associated hepatotoxicity and related factor.

METHODSLiterature retrieval was conducted by using multi-databases for meta-analysis on Ketoconazole associated hepatotoxicity. The data were collected with a standardized form. Overall estimation of incidence of hepatotoxicity for specific study type was calculated by using a DerSimonian-Laird random-effects model owing to the substantial differences among the studies.

RESULTSTotally 204 eligible studies were included in the analysis. The incidence of Ketoconazole associated hepatotoxicity was 3.6%-4.2%. The dosage and duration specific subgroup analyses did not show any significant difference among groups, while the age specific subgroup analysis showed the incidence in children and people aged >60 years was 1.4% (95% CI: 0.5%-4.2%) and 3.2% (95% CI: 1.1%-8.7%) respectively. Additionally, the incidence of the hepatotoxicity was higher in people who had oral administration of ketoconazole beyond the provisions of the usage instructions, and the incidence was 5.7% (95% CI: 4.5%-7.2%).

CONCLUSIONKetoconazole associated hepatotoxicity was common. Off-label use might increase the risk of liver damage. Well-designed large sample studies are needed to identify the risk factors in future.

Antifungal Agents ; administration & dosage ; adverse effects ; Chemical and Drug Induced Liver Injury ; etiology ; Humans ; Ketoconazole ; administration & dosage ; adverse effects ; Off-Label Use

Pneumocystis pneumonia (PCP) is among the most common opportunistic infections in patients with acquired immune deficiency syndrome (AIDS). Although trimethoprim-sulfamethoxazole (TMP-SMX) is the first line therapy for that condition given its efficacy, approximately one third of patients experienced dose-limiting toxicity. For cases of severe to moderate PCP, if TMP-SMX treatment fails or is contraindicated, primaquine combined with clindamycin or intravenous pentamidine is recommended as second line therapy. However, both primaquine and pentamidine are associated with severe adverse reactions and often unavailable at hospitals in China.As a result, other treatment options have been explored. Caspofungin, an echinocandin, has broad antifungal activity against a wide range of fungi including Candida and Aspergillus species. Cases of PCP patients treated with caspofungin have been reported, although conflicting conclusions have been arrived at. In addition, the use of caspofungin and clindamycin as the first line therapy for severe PCP in AIDS patients has not been reported yet. This article described an AIDS case with severe PCP, treated with the combination of caspofungin and clindamycin.
AIDS-Related Opportunistic Infections ; drug therapy ; Adult ; Anti-Bacterial Agents ; administration & dosage ; Antifungal Agents ; administration & dosage ; Clindamycin ; administration & dosage ; Drug Therapy, Combination ; Echinocandins ; administration & dosage ; Humans ; Lipopeptides ; Male ; Pneumonia, Pneumocystis ; drug therapy

Neutrophils play an important role in immunological function. Neutropenic patients are vulnerable to infection, and except fever is present, inflammatory reactions are scarce in many cases. Additionally, because infections can worsen rapidly, early evaluation and treatments are especially important in febrile neutropenic patients. In cases in which febrile neutropenia is anticipated due to anticancer chemotherapy, antibiotic prophylaxis can be used, based on the risk of infection. Antifungal prophylaxis may also be considered if long-term neutropenia or mucosal damage is expected. When fever is observed in patients suspected to have neutropenia, an adequate physical examination and blood and sputum cultures should be performed. Initial antibiotics should be chosen by considering the risk of complications following the infection; if the risk is low, oral antibiotics can be used. For initial intravenous antibiotics, monotherapy with a broad-spectrum antibiotic or combination therapy with two antibiotics is recommended. At 3-5 days after beginning the initial antibiotic therapy, the condition of the patient is assessed again to determine whether the fever has subsided or symptoms have worsened. If the patient's condition has improved, intravenous antibiotics can be replaced with oral antibiotics; if the condition has deteriorated, a change of antibiotics or addition of antifungal agents should be considered. If the causative microorganism is identified, initial antimicrobial or antifungal agents should be changed accordingly. When the cause is not detected, the initial agents should continue to be used until the neutrophil count recovers.
Anti-Bacterial Agents/*administration & dosage ; Antibiotic Prophylaxis/*standards ; Antifungal Agents/*administration & dosage ; Drug Administration Schedule ; Evidence-Based Medicine ; Fever/diagnosis/*drug therapy/etiology ; Humans ; Neutropenia/diagnosis/*drug therapy/etiology ; Republic of Korea ; Time Factors ; Treatment Outcome

We describe two cases of disseminated mucormycosis following allogeneic bone marrow transplantation (BMT). Both patients were suffering from chronic graft-ver-sus-host disease (GVHD) and treated with prolonged administration of corticosteroid. In both cases, the initial symptoms were high fever and left flank pain. Involved organs were the spleen, right kidney and the right lung in one case, and the spleen and the brain in the other. The diagnosis was confirmed by pathology after splenectomy. One patient, in whom the immunosuppressesants could be discontinued, was treated with prolonged conventional and liposomal amphotericin B and 5-fluorocytosine. The other, in whom the immunosuppressants could not be discontinued due to extensive GVHD, was unresponsive to amphotericin B, and eventually died from the fungal infection. Although mucormycosis, especially the disseminated form thereof is infrequent, it should be considered in high-risk patients because early diagnosis and timely therapy combining antifungal drug or surgery and reduction of immunosuppression appear to improve the prognosis.
Adult ; Amphotericin B/administration & dosage ; Antifungal Agents/administration & dosage ; *Bone Marrow Transplantation ; Fatal Outcome ; Humans ; *Immunocompromised Host ; Immunosuppressive Agents/administration & dosage ; Male ; Mucormycosis/drug therapy/immunology/*pathology ; Transplantation, Homologous

OBJECTIVETo explore the rate of compliance, influencing factors and the safety of patients with onychomycosis under treatment of oral antifungal agents.

METHODSAccording to the scoring clinical index of onychomycosis (SCIO), 330 patients with onychomycosis, their target nail's integral of the SCIO were calculated and randomly divided into three groups under the baseline of the SCIO integral range. Patients were treated with intermittent pulse itraconazole (A group), continuous terbinafine (B group) and intermittent terbinafine (C group) respectively. Self-administered questionnaire was applied in the survey on every onychomycosis patient.

RESULTSThe average rate of compliance was 55.15%. The cure rate for those compliance with doctors' order was 89.01%, while it was only 30.41% for those noncompliant patients The overall non-compliant rate was 44.85%. Among the noncompliant ones, 29.73% were worried about the side effects of medicine, 22.30% thought that they had already been cured, 15.54% was due to economic reasons and 12.16% could not bear the side effects of medicine. It was found that the compliant rates were significantly correlated to ageing, position of the target nails, the integral of the SCIO and the therapy scheme (P < 0.05), while no significant correlations were seen between male and female, culture degree and course (P > 0.1). The frequency of adverse incident of A, B, C groups were 22.73%, 21.43%, 23.15% respectively, but without statistical significance (P > 0.1). Majority of the adverse incidents happened during the first month of therapy but were mild and reversible.

CONCLUSIONOur results showed that the overall compliance was low which exerted a significant influence on the curative effect of onychomycosis patients. Factors as ageing, position of the target nail, integral of the SCIO and the therapy scheme had an influence on the compliant rate. When treating onychomycosis with oral itraconazole, the results seemed to be just as safe as when using terbinafine.

Administration, Oral ; Age Factors ; Antifungal Agents ; administration & dosage ; adverse effects ; economics ; Dose-Response Relationship, Drug ; Female ; Humans ; Itraconazole ; administration & dosage ; adverse effects ; economics ; Male ; Naphthalenes ; administration & dosage ; adverse effects ; economics ; Onychomycosis ; drug therapy ; Patient Compliance ; statistics & numerical data ; Surveys and Questionnaires