Treatment for Fungal Infections
Underlying conditions can predispose a patient to fungal infections. For example, if someone with a fungal infection has diabetes, his or her sugar level may need to be brought under control before treatment can be effective.
A depressed immune system may need to be treated for antifungals to work. When someone affected has been using antibiotics or corticosteroids, they may have to stop or taper those medications in order to aid fungus treatment.
Medications to Treat Fungal Infection
A doctor generally matches the medication, topical or oral, to the organism against which it is effective. One oral antifungal used commonly over the years, griseofulvin, is effective for treating tinea capitis, for example, but not candida and certain mold infections. The drug ketoconazole (Nizoral) is effective against tinea versicolor but not against other fungal infections.
Many new broad-spectrum antifungal agents effectively treat a wide range of organisms. Thus, doctors can start patients on a regimen of antifungals without waiting for culture results. These newer antifungals include itraconazole (Sporanox), terbinafine (Lamisil), fluconazole (Diflucan), and isavuconazonium (Cresemba). Typical courses for each:
- Itraconazole: "pulse" therapy—1 week on, 3 weeks off
- Terbinafine: continuous once-daily therapy
- Fluconazole: continuous once-weekly therapy
- Isavuconazonium: capsules or intravenous (IV) administration
The medication and therapy regimen is chosen based on the type and extent of the infection. Some work well in the short term, while others have a longer-lasting effect. Some work well in small quantities, while others require larger doses to be effective.
Side effects of oral antifungals include nausea, gastrointestinal distress, diarrhea, abdominal pain, skin rashes, headache, and fatigue. Typically, a small number of patients taking these medications have one of these unusual reactions. If the side effects are bothersome or create concern, the drug can be discontinued. The doctor may order a blood test to check liver function, especially during long-term therapy, if the patient has an already weakened liver, or is using high doses of medication.
Patient, doctor, and pharmacist should be aware of potential side effects, some of which may be severe. The doctor may be able to suggest treatments to minimize the side effects.
In July 2013, the U.S. Food and Drug Administration (FDA) began limiting the use of ketoconazole (Nizoral) oral tablets and issued a warning that the drug can cause severe liver injuries and adrenal gland problems and lead to harmful drug interactions with other medications. The FDA approved label changes and added a new Medication Guide to address these safety issues. Nizoral oral tablets should not be a first-line treatment for any fungal infection and should be used only for certain infections when other therapies are unavailable or not tolerated.
Topical forms of Nizoral, including creams, shampoos, foams, and gels applied to the skin, have not been associated with liver damage, adrenal problems, or drug interactions.
Follow-up Treatment for Fungal Infections
A patient should receive effective follow-up care. Fungal infections can recur and treatments are usually more successful if started early.