Fungal Infections

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Treatment

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
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. Three of these new antifungals are itraconazole (Sporanox®), terbinafine (Lamisil®), ), and fluconazole (Diflucan®), ). A typical course for each follows:

• Itraconazole: "pulse" therapy—1 week on, 3 weeks off
  
• Terbinafine: continuous once-daily therapy
  
• Fluconazole: continuous once-weekly therapy

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. The effects need not cause anyone to stop taking a medication. The doctor may be able to suggest treatments to minimize the side effects.

Follow-up Treatment
A patient should receive effective follow-up care. Fungal infections can recur and treatments are usually more successful if started early.

Prevention

There are two main approaches to preventing fungal infection. One is to avoid contact with the organism. This can be achieved by not sharing hats, combs, brushes, or other objects, especially when fungus infections are present. Wearing flip-flops or shoes in locker rooms, public showers, and around swimming pools can help reduce contact with athlete's foot fungus.

The other approach is managing the environment to avoid enhancing fungus growth. Reduce moisture and humidity on the skin by drying it thoroughly and by changing sweaty clothes and socks. Cleaning or discarding infected objects and garments also helps prevent recurrences.

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