Orally effective drug in candidiasis:
Correct Answer: Itraconazole
Description: Ans: d (Itraconazole) Ref: Tripathi, 6th ed, p. 759; Goodman and Gilman's, 11th ed, p. 810Candidiasis1st choice2nd choiceOral/vaginal/cutaneousFlucanozole/nystatin/ ClotrimazoleItraconazoleDisseminatedAmphotericin B/ VoriconazoleFluconazoleItraconazole is used orally for candidiasis.lt has broader spectrum than fluconazole and ketoconazole. It is fungistatic, but effective in immunocompromised patients. Oral itraconazole is the drug of choice for patients with indolent, nonmeningeal infections due to B. demiatitidis, H.capsulatum, P.brasiliensis, and C.immitis and also is useful for indolent invasive aspergillosis outside the CNS, particularly following initial therapy with amphotericin B. The intravenous formulation is approved for the initial 2 weeks of therapy for blastomycosis, histoplasmosis, and indolent aspergillosis, and for empirical therapy of febrile neutropenic patients not responding to antibiotics and at high risk of fungal infections. The intravenous route is most appropriate for patients unable to tolerate oral drug or unable to absorb itraconazole because of decreased gastric acidity.Micanozole and clotrimazole are topical azolesMechanism of action of antifungals5 -Flucytosine inhibits thymidylate synthase and thus inhibits DNA synthesisAmphotericin binds with ergosterol of the cell membrane and forms pores that increase membrane permeability and allow leakage of small moleculesGnseofulvin inhibits fungal mitosis, presumably disrupting the mitotic spindle by interacting with polymerized microtubules.Griseofulvin also may bind to a microtubule-associated protein.Terbinafine is a synthetic allylamine that is structurally similar to naftifine. It probably acts by inhibiting fungal squalene epoxidase and blocking ergosterol biosynthesis
Category:
Pharmacology
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