Daily Healthy: Indication

Needle Stick Injury: HIV Prophylaxis

<div class="MsoNormal">Risk of seroconversion</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">Deep injury (odds ratio [OR] 15)</li><li class="MsoNormal">A device visibly contaminated with the patient's blood (OR 6.2)</li><li class="MsoNormal">Needle placement in a vein or artery (OR 4.3)</li><li class="MsoNormal">Terminal illness in the source patient (OR 5.6)</li><li class="MsoNormal">The majority of cases were injured by a hollow bore as opposed to a solid needle</li></ul> <div class="MsoNormal">Initial actions following exposure</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">immediate cleansing of the exposed site.</li><li class="MsoNormal">Small wounds and punctures may be cleansed with an antiseptic such as an alcohol-based hand hygiene agent, since alcohol is virucidal to HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV).</li><li class="MsoNormal">Other antiseptics such as iodophors, chloroxylenol (PCMX) and <a href="https://www.uptodate.com/contents/chlorhexidine-gluconate-drug-information?source=see_link">chlorhexidine</a> (CHG) also inactivate HIV</li></ul> <div class="MsoNormal">Testing for HIV </div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">Baseline and follow-up serologic testing for HIV should be performed in all HCP exposed to HIV to see if seroconversion occurred.</li><li class="MsoNormal">The majority of individuals who seroconvert will do so within the first three months.</li><li class="MsoNormal">Testing should be performed even among those who receive PEP</li></ul> <div class="MsoNormal">Post Exposure Prophylaxis </div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">offer post-exposure prophylaxis (PEP) using a three-drug regimen to healthcare personnel (HCP) with a percutaneous, mucous membrane, or nonintact skin exposure to body fluids of concern (eg, blood or blood tinged fluids) if the source patient is, or is suspected to be, HIV-infected</li><li class="MsoNormal">PEP should be discontinued if testing shows that the source patient is HIV-negative, unless there is concern that the source is acutely infected with HIV</li><li class="MsoNormal">If the HIV status of the source patient is unknown, offer PEP while awaiting HIV testing if the source has risk factors for HIV infection (eg, injection drug users, men who have sex with men) or symptoms suggesting HIV infection.</li><li class="MsoNormal">If the source patient is unknown, do not administer PEP unless the exposure occurred in a setting where exposure to HIV is likely (eg, a needlestick from a sharps container in an HIV clinic</li></ul> <div class="MsoNormal">Timing </div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">PEP should be initiated as soon as possible.</li><li class="MsoNormal">The goal is to start within one to two hours (or earlier) after exposure, often using a "starter pack" with appropriate drugs that are immediately available.</li><li class="MsoNormal"> It is likely that a delay in initiating PEP can reduce efficacy</li><li class="MsoNormal">For most HCP, we do not initiate PEP if more than 72 hours have elapsed after the initial exposure; PEP is likely to be less effective when administered after that period of time.</li><li class="MsoNormal"> However, we offer three-drug PEP after a longer interval to patients with a very high-risk exposure (eg, sharps injuries from a needle that was in an artery or vein of an HIV-infected source patient).</li><li class="MsoNormal">For such HCP, The United States Public Health Services suggests that PEP can be offered up to one week after the exposure</li></ul> <div class="MsoNormal">Selection of antiretroviral therapy</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">Tenofovir-emtricitabine (300/200 mg once daily) plus <a href="https://www.uptodate.com/contents/raltegravir-drug-information?source=see_link">raltegravir</a> (400 mg twice daily)</li><li class="MsoNormal">Tenofovir-emtricitabine (300/200 mg once daily) plus <a href="https://www.uptodate.com/contents/dolutegravir-drug-information?source=see_link">dolutegravir</a> (50 mg once daily)</li></ul> <div class="MsoNormal">PEP during pregnancy</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal"> For pregnant HCP who have an occupational exposure to HIV and choose to initiate post-exposure prophylaxis (PEP), we typically use the same regimen as noted above, namely tenofovir-emtricitabine (available as Truvada) plus <a href="https://www.uptodate.com/contents/raltegravir-drug-information?source=see_link">raltegravir</a></li></ul> <div class="MsoNormal">Duration of therapy </div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">The recommended duration of PEP is four weeks because a course of <a href="https://www.uptodate.com/contents/zidovudine-drug-information?source=see_link">zidovudine</a> for this duration appeared protective in some studies; however, the optimal duration of PEP is unknown</li><li class="MsoNormal">PEP should be discontinued if testing shows that the source patient is HIV-negative </li></ul><div class="MsoNormal">Reference:</div> <div class="MsoNormal">www.uptodate.com</div>

dose Indication other Needle Stick Injury: HIV Prophylaxis

Risk of seroconversion Deep injury (odds ratio [OR] 15) A device visibly contaminated with the patient's blood (OR 6.2) Needle placemen...

Lactulose in Diabetes

10:35 AM Meme Art Studio 0 Comment

<div class="MsoNormal">Lactulose</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">consists of the monosaccharides fructose and galactose</li><li class="MsoNormal">In the colon, lactulose is broken down primarily to lactic acid, and also to small amounts of formic and acetic acids, by the action of via evolved-beta galactosidase from colonic bacteria, which results in an increase in osmotic pressure and slight acidification of the colonic contents.</li><li class="MsoNormal">This in turn causes an increase in stool water content and softens the stool.</li><li class="MsoNormal">In treating heptic diseases (hepatic encephalopathy) it is thought that lactulose draws out ammonia from the body in the same way that it draws out water into the colon.</li></ul> <div class="MsoNormal">Affect on Sugar level</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">The interaction of lactulose and diabetes is categorised as ‘moderate’</li><li class="MsoNormal">Product information states that there is a possibility of affected glycaemic control</li><li class="MsoNormal">Lactulose may contain more than 5 g lactose/galactose/epilactose depending upon the dose taken. This should be taken into account in patients with diabetes mellitus. [15 ml of Lactulose contain 42.7 KJ (10.2 kcals) = 0.21 BU]</li></ul> <div class="MsoNormal">Glycaemic Index</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">In terms of glycaemic Index, comparatively lactose (45) and galactose (25) has lower index compared to glucose (100).</li><li class="MsoNormal">However do keep in mind that GI value represents the type of carbohydrate in a food but says nothing about the amount of carbohydrate typically eaten. Thus, a higher consumption of lower index food is still able to increase the sugar level</li></ul> <div class="MsoNormal">Studies: Galactose</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">Following galactose ingestion, there was a modest transient increase in peripheral glucose and insulin concentrations. This was associated with a modest increase in the glucose Ra (rate of glucose appearance)</li><li class="MsoNormal">conversion of galactose to glucose in the liver may have been greater than suggested by the increase in glucose appearance in the circulation due to substitution for other gluconeogenic substrates</li><li class="MsoNormal">Oral galactose is a relatively potent insulin secretagogue, and the insulin response is also additive to that following glucose ingestion</li></ul> <div class="MsoNormal">Studies: Lactose</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">decrease in the glucagon area response observed with 25 g galactose + 25 g glucose or 50 g lactose was less than that with ingestion of 25 g glucose alone. The latter suggests inhibition of the glucagon response to glucose by the added galactose</li></ul> <div class="MsoNormal">Studies : Lactulose</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">In a study to test the effects of a preparation containing fibre and lactulose in the form of biscuits on glucose and insulin levels in obesity, they found a contradicting trend that glucose and insulin in response to breakfast and to lunch were blunted by dietary fibre and lactulose, without any trend towards post-meal hypoglycaemia</li><li class="MsoNormal">However, there is also a single case report that reported a case of a patient with diet-controlled diabetes and cirrhosis who experienced a marked deterioration in glycemic control, requiring insulin use, when he began using a different brand of lactulose syrup. The hyperglycemia resolved and insulin was discontinued after use of the original brand of lactulose syrup was resumed</li></ul> <div class="MsoNormal">Recommendations</div> <ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal">Most references suggest of being cautious to the addition of lactulose. However this is not a contraindication</li><li class="MsoNormal">While may affect the sugar level, most likely it will not affect levels significantly to the extent of impacting diabetes control</li><li class="MsoNormal">Based on guidelines and data from published literature, food and dietary change with exercise and lifestyle change should be the first step in management. For patients recalcitrant to these changes, laxatives should be the next step of treatment. Treatment should begin with bulking agents such as psyllium, bran or methylcellulose followed by osmotic laxatives if response is poor</li></ul> <div class="MsoNormal">References:</div> <ol start="1" style="margin-top: 0cm;" type="1"><li class="MsoNormal"><a href="https://www.drugs.com/disease-interactions/lactulose.html">https://www.drugs.com/disease-interactions/lactulose.html</a></li><li class="MsoNormal"><a href="https://www.ncbi.nlm.nih.gov/pubmed/11172481">https://www.ncbi.nlm.nih.gov/pubmed/11172481</a></li><li class="MsoNormal"><a href="http://www.metabolismjournal.com/article/0026-0495(93)90151-D/pdf">http://www.metabolismjournal.com/article/0026-0495(93)90151-D/pdf</a></li><li class="MsoNormal"><a href="https://www.medicines.org.uk/emc/medicine/25597">https://www.medicines.org.uk/emc/medicine/25597</a></li><li class="MsoNormal"><a href="https://beta.nhs.uk/medicines/lactulose/">https://beta.nhs.uk/medicines/lactulose/</a></li><li class="MsoNormal"><a href="https://www.ncbi.nlm.nih.gov/pubmed/9145450">https://www.ncbi.nlm.nih.gov/pubmed/9145450</a></li><li class="MsoNormal"><a href="https://www.ncbi.nlm.nih.gov/pubmed/7716610">https://www.ncbi.nlm.nih.gov/pubmed/7716610</a></li><li class="MsoNormal"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27987136">https://www.ncbi.nlm.nih.gov/pubmed/27987136</a> </li></ol>

Indication Others Lactulose in Diabetes

Lactulose consists of the monosaccharides fructose and galactose In the colon, lactulose is broken down primarily to lactic acid, and also ...

Comparison of oral antifungals

3:07 PM Meme Art Studio 0 Comment

<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Availability in Hospital Keningau</div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l9 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Cap Fluconazole 50mg & 200mg</li><li class="MsoNormal" style="line-height: normal; mso-list: l9 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Tab Griseofulvin 125mg</li><li class="MsoNormal" style="line-height: normal; mso-list: l9 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Cap Itraconazole 100mg</li><li class="MsoNormal" style="line-height: normal; mso-list: l9 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Tab Ketoconazole 200mg </li><li class="MsoNormal" style="line-height: normal; mso-list: l9 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Suspension Nystatin 100 000 units/ml </li></ul><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Comparison of Oral Antifungals </div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; mso-padding-alt: 0cm 0cm 0cm 0cm; mso-yfti-tbllook: 1184; width: 615px;"> <tbody><tr style="height: 11.75pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid windowtext 1.0pt; height: 11.75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.75pt;" valign="top" width="104"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Antifungal</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; height: 11.75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 220.35pt;" valign="top" width="294"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Indication (FUKKM)            </div></td> <td style="border-left: none; border: solid windowtext 1.0pt; height: 11.75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 165.15pt;" valign="top" width="220"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Pharmacokinetics</div></td> </tr><tr style="height: 94.7pt; mso-yfti-irow: 1;"> <td style="border-top: none; border: solid windowtext 1.0pt; height: 94.7pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.75pt;" valign="top" width="104"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Ketoconazole</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">200mg</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">(B)</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 94.7pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 220.35pt;" valign="top" width="294"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l5 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Pityriasis Versicolor</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l35 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Systemic Mycoses (other skin mycosis)</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l15 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Nail infection</li></ul></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 94.7pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 165.15pt;" valign="top" width="220"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Absorption can be increased by administration with a cola beverage (requires acidic condition)</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l24 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Half life elimination is biphasic (initial 2 hours and terminal 8 hours)</li></ul></td> </tr><tr style="height: 131.45pt; mso-yfti-irow: 2;"> <td style="border-top: none; border: solid windowtext 1.0pt; height: 131.45pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.75pt;" valign="top" width="104"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Fluconazole 50mg</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Fluconazole 100mg</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">(A)</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 131.45pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 220.35pt;" valign="top" width="294"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l36 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Oropharyngeal candidiasis, atrophic oral candidiasis</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l11 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Tinea Pedis, corporis, cruris, versicolor and dermal candidiasis</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l6 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Invasive candida & cryptocococcal infections (includes meningitis)</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l4 level1 lfo10; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Prevention of relapse cryptococcal meningitis in AIDS after completion of primary therapy</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l17 level1 lfo11; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Prevention of fungal infections in immunocompromised patients</li></ul></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 131.45pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 165.15pt;" valign="top" width="220"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l23 level1 lfo12; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Oral bioavailability > 90%</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo13; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">The long serum half-life (approximately 24 hours) allows once-daily dosing</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l19 level1 lfo14; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Good penetration into CSF</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l21 level1 lfo15; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Absorption is not affected by the presence of food or gastric pH.</li></ul></td> </tr><tr style="height: 97.65pt; mso-yfti-irow: 3;"> <td style="border-top: none; border: solid windowtext 1.0pt; height: 97.65pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.75pt;" valign="top" width="104"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Itraconazole 100mg</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">(A/KK)</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 97.65pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 220.35pt;" valign="top" width="294"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l41 level1 lfo16; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Dermatomycosis including pityriasis versicolor</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l12 level1 lfo17; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Oral candidiasis</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l10 level1 lfo18; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Palmar tinea manus and plantar tinea pedis</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l33 level1 lfo19; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Fingernail onychomycosis</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l27 level1 lfo20; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Toenail onychomycosis</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l26 level1 lfo21; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Vulvovaginal candidiasis</li></ul></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 97.65pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 165.15pt;" valign="top" width="220"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l31 level1 lfo22; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Capsule bioavailability of approximately 55%</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l14 level1 lfo23; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Relatively long half-life, approaching 25 to 50 hours thus allows OD dosing</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l18 level1 lfo24; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Absorption increased by concurrent ingestion of cola or cranberry juice</li></ul></td> </tr><tr style="height: 97.65pt; mso-yfti-irow: 4;"> <td style="border-top: none; border: solid windowtext 1.0pt; height: 97.65pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.75pt;" valign="top" width="104"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Voriconazole 200mg</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Voriconazole 50mg</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">(A*)</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 97.65pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 220.35pt;" valign="top" width="294"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l40 level1 lfo25; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Treatment of immunocompromised patients with progressive, possibly life-threatening infections such as invasive aspergillosis, fluconazole-resistant serious invasive candidiasis, candidiasis of the oesophagus, serious fungal infections caused by Scedosporium species and Fusarium species</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l22 level1 lfo26; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Prevention of breakthrough fungal infections in febrile high risk neutropenic patients</li></ul><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 97.65pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 165.15pt;" valign="top" width="220"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l38 level1 lfo27; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Oral biovailability >90% in adult and may vary with <12 year old</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l7 level1 lfo28; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Ability to penetrate CSF</li></ul><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div></td> </tr><tr style="height: 82.95pt; mso-yfti-irow: 5;"> <td style="border-top: none; border: solid windowtext 1.0pt; height: 82.95pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.75pt;" valign="top" width="104"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Syr. Nystatin</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">500 000</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">(B)</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 82.95pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 220.35pt;" valign="top" width="294"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l16 level1 lfo29; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Prevention and treatment of candidiasis of the skin and mucous membranes</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l13 level1 lfo30; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Protection against candidas overgrowth during antimicrobial /corticosteroid therapy and as selective decontamination regimens</li></ul></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 82.95pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 165.15pt;" valign="top" width="220"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l32 level1 lfo31; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Poorly absorbed</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l34 level1 lfo32; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Excreted unchanged at feces </li><li class="MsoNormal" style="line-height: normal; mso-list: l34 level1 lfo32; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Should be swished about the mouth and retained in the mouth for as long as possible (several minutes) before swallowing.</li></ul></td> </tr><tr style="height: 35.25pt; mso-yfti-irow: 6;"> <td style="border-top: none; border: solid windowtext 1.0pt; height: 35.25pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.75pt;" valign="top" width="104"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Griseofulvin</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">(B)</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 35.25pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 220.35pt;" valign="top" width="294"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo33; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Dermatophyte infection of the skin, scalp, hair and nails, where topical therapy has failed or inappropriate</li></ul></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 35.25pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 165.15pt;" valign="top" width="220"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l25 level1 lfo34; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Absorption is almost complete (ultramicrosize)</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l29 level1 lfo35; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Half life elimination is 9-24 hours</li></ul></td> </tr><tr style="height: 35.25pt; mso-yfti-irow: 7; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid windowtext 1.0pt; height: 35.25pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.75pt;" valign="top" width="104"> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Flucytosine 500mg</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">(A*)</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 35.25pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 220.35pt;" valign="top" width="294"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l8 level1 lfo36; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Only for the treatment of fungal meningitis</li></ul></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 35.25pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 165.15pt;" valign="top" width="220"> <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l28 level1 lfo37; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Ability to penetrate CSF</li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l39 level1 lfo38; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Bioavailability 78%-89% (decreased in neonates</li></ul></td> </tr></tbody></table><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Spectrum of activity</div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDAGd24XuNU3N5SQwJ2MssteHz-cDqYHTwtsnQAdQRMOm-bvxHZxaHUQnYawA88OSFV_I1IRPZXaVxbiRLDtyV77DRKIn_ItJzwkfwMVXDtHPez0TDjP2_k5yuTWd5OvhcXBBeYYyJy4s/s1600/Spectrum+of+activity.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="481" data-original-width="580" height="528" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDAGd24XuNU3N5SQwJ2MssteHz-cDqYHTwtsnQAdQRMOm-bvxHZxaHUQnYawA88OSFV_I1IRPZXaVxbiRLDtyV77DRKIn_ItJzwkfwMVXDtHPez0TDjP2_k5yuTWd5OvhcXBBeYYyJy4s/s640/Spectrum+of+activity.jpg" width="640" /></a></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> </div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Imidazole (Ketoconazole)</div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l20 level1 lfo39; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Ketoconazole causes more gastrointestinal disturbances compared to other azoles.</li><li class="MsoNormal" style="line-height: normal; mso-list: l20 level1 lfo39; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Has been largely replaced by other triazoles due to favourable pharmacokinetic and safety profile</li><li class="MsoNormal" style="line-height: normal; mso-list: l20 level1 lfo39; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Should not be used as first-line treatment for any fungal infection.</li><li class="MsoNormal" style="line-height: normal; mso-list: l20 level1 lfo39; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">It should be used for the treatment of endemic mycoses (eg, histoplasmosis, blastomycosis) only when alternative antifungal therapies are not available or tolerated.</li><li class="MsoNormal" style="line-height: normal; mso-list: l20 level1 lfo39; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Contraindicated in acute or chronic liver disease.</li></ul><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Triazole (Itraconazole, Fluconazole, Voriconazole)</div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l30 level1 lfo40; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">The drugs in this class offer activity against many fungal pathogens without the serious nephrotoxic effects observed with amphotericin B </li><li class="MsoNormal" style="line-height: normal; mso-list: l30 level1 lfo40; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Due to its inotropic effects, itraconazole’s labeling includes a black box warning in patients with heart failure, particularly in patients receiving a total daily oral dose of 400 mg</li></ul><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">Pyrimidine (Flucytosine)</div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l37 level1 lfo41; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Flucytosine has limited clinical indication and is used primarily in combination with Amphotericin B as combination therapy for cryptococcal meningitis and selected life threatening Candida syndromes                  </li></ul><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">References</div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo42; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Uptodate</li><li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo42; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">https://mycology.adelaide.edu.au/docs/antifungals.pdf </li><li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo42; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">https://www.uspharmacist.com/article/the-fungus-among-us-an-antifungal-review </li><li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo42; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">Lexicomp </li><li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo42; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;">FUKKM  </li></ul>

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