Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++Figure 27-1.Graphic Jump LocationView Full Size||Download Slide (.ppt)Classification of fungi & pathophysiology of disease. ++Table Graphic Jump LocationTable 27-1 Antifungal Drug Susceptibility Rates Against Common Fungal Pathogens (Clin Infect Dis 2009;48:503; J Clin Microbiol 2010;48:3251)View Table||Download (.pdf)Table 27-1 Antifungal Drug Susceptibility Rates Against Common Fungal Pathogens (Clin Infect Dis 2009;48:503; J Clin Microbiol 2010;48:3251)Fungal PathogenFluconazoleItraconazoleVoriconazolePosaconazoleEchinocandinsAmphotericin BCandida spp. (% of occurrence)C. albicans (50–60%)++++++++++++++++++C. glabrata (10–20%)+-++++++++++C. tropicalis (6–10%)++++++++++++++++C. parapsilosis (6–10%)+++++++++++++++C. krusei (2–3%)--++++++++++++Aspergillus spp. (% of occurrence)A. fumigates (75–80%)-+++++++++++++++A. flavus (10–12%)-+++++++++++++++A. niger (6–8%)-+++++++++++++++A. terreus (4–6%)-++++++++++++-+ + +, >95% susceptible; ++, 75–95% susceptible; +, 50–75% susceptible; −, negligible activity. +++ Dermatophytoses +++ Diagnosis & Evaluation ++ Visualize hyphae after 1 drop of 10–20% KOH added to active lesion border scraping; higher sensitivity (76.5%) & negative predictive value (81.6%) vs culture +++ Treatment & Follow-Up ++ Tinea capitis: terbinafine 250mg PO daily × 4wk; adjunctive selenium sulfide 2.5% shampoo 2–3×/wk to ↓ spreadTinea corporis, tinea cruris, tinea pedis: combination antifungal/corticosteroid preparations not recommended due to ↑ cost, ↑ risk for adverse effects, & ↓ response ratesTinea unguium (onychomycosis): may withhold treatment for asymptomatic individuals with minimal nail involvement; treat associated tinea pedis in all patients; draw LFTs at baseline & at 4–6wk for terbinafine; for fingernails → terbinafine 250mg PO QD × 6wk (clinical cure rate ∼50%); for toenails → terbinafine 250mg PO QD × 12wk (clinical cure rate ∼50%) (BMJ 1999; 318:1031); allows 48–72wk for nail growth & to assess clinical cure; in patients with contraindications to systemic therapy (active or chronic liver disease) or minimal distal dermatophyte infection → ciclopirox 8% nail lacquer daily × 48wk + podiatric debridement (mycological cure rate ∼30%; clinical cure rate <10%) (J Am Acad Dermatol 2004;50:151) ++Table Graphic Jump Location | Download (.pdf) | PrintClinical Pearl 27-1Topical terbinafine therapy can be applied once daily for 7d for tinea corporis, tinea cruris, & tinea pedis. All other products must be applied for 2–4wk.++Table Graphic Jump Location | Download (.pdf) | PrintClinical Pearl 27-2Clinical cure rates ∼25% in patients >65yo (Am J Geriatr Pharmacother 2006;4:1).++Table Graphic Jump LocationTable 27-2 Topical Antifungal Agents for the Treatment of Tinea Corporis, Tinea Cruris, & Tinea PedisView Table||Download (.pdf)Table 27-2 Topical Antifungal Agents for the Treatment of Tinea Corporis, Tinea Cruris, & Tinea PedisDrug NameAvailabilityDosingOTC?Generic?Allylamines... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth