Anti-Fungus

MACP 2113

Disediakan oleh:
Pengajar U41
KSKBSAS

OBJEKT
IF
1. Memberi definisi agen antifungus.
2. Menyatakan tujuan/ indikasi ubat.
3. Menyatakan dos dan contoh ubat.

4. Menyatakan kaedah pemberian

ubat.
5. Menyatakan tindakan ubat.
6. Menerangkan kesan sampingan
dan kontraindikasi ubat.
7. Memberikan nasihat spesifik
dalam pengambilan ubat.

Anti-Fungus
Ubat yang digunakan untuk
merawat jangkitan fungus.

Tindakan Anti-Fungus
Fungicidal - Membunuh kulat
Fungistatic - Menghalang
pembiakan/ pertumbuhan kulat

Contoh ubat
Clotrimazole (Lotremin)
Griseofulvin (Fulvicin)
Miconazole Nitrate (Daktarin)
Nystatin (Mycostatin)
Ketoconazole (Nizoral
Amphotericin B (Fungizone)
Amphotericin B eye drops

1. Clotrimazole 1%
solution
(Canestan)
Category: A

Indication
Vaginal candidiasis
Tinea infection
Cutaneous candidiasis

Tindakan
Fungicidal & Fungistatic:
Bergabung dengan cell
membrane fungus.
Menyebabkan perubahan
dalam ketelapan membrane.
Kemudian memusnahkan
sel tersebut.

Dose
Apply bd-tds
Continue for 14 days
after lesion have
healed

2. Clotrimazole 1% cream
(Canestan)
Category: B

Indication
Same as solution

Dose
Rub gently onto affected &
surrounding skin area bd-tds.
Continue for 14 days after
lesion have healed

Kesan sampingan

Stinging
Blistering
Peeling
Pruritis
Urticaria
Irritation
Burning

Contraindication
Allergic to Clotrimazole

Cautious
Pregnancy
Lactation

Interaction
Not found

3. Clotrimazole 200mg/500mg
vaginal tablet
(Canestan)
Category: B

Indication
Vaginal candidiasis

Dose
200mg tablet
200mg/day (preferably hs) for
3 consecutive days

500mg tablet
500mg as a single one time
dose

Kesan sampingan
Local irritation
Burning (mild)
Allergic reactions

Contraindication
Allergic to Clotrimazole

Cautious
Pre-existing hepatic impairment
Pregnancy

Interaction
Betamethasone
Superinfections

Tacrolimus
Meningkatkan paras serum
tacrolimus

4. Griseofulvin (Fulvicin)
Category: B

Indication
Infeksi fungus pada kulit,
rambut, kulit kepala &
kuku.

Tindakan
Fungicidal:
Berkumpul dalam sel
prekusor keratin.
Memusnahkan sel tersebut
bersama fungus.
Sel baru yang terbentuk
adalah bebas dari fungus.

Dose (tablet)
Adult:
500mg/day up to 1g/day
(divided dose)

Peads:
10mg/kg/day PO (divided
dose)

Dose (syrup)
Peads up to 1 yr:
62.5mg bd

Peads 1-5 yr:

62.5mg tds

Peads 6-12 yr:

125mg bd-tds

Kesan sampingan

Headache
Dizziness
Rash
Urticaria
GI disturbances
Photosensitivity
Peripheral neuropathy

Contraindication

Allergic to Griseofulvin
Hepatic Failure
SLE
Pregnancy

Cautious
Lactation
*Male should not father child
within 6 months of treatment
(damage sperm cells)

Interaction
Barbiturates
Kurangkan penyerapan
griseofulvin

Warfarin & Oral

contraceptives
Pengurangan dalam kesan
ubat di atas

 Alcohol
Tingkatkan kesan alcohol

5. Miconazole Nitrate 2%
cream (Daktarin)
Category: B

Indication
Vulvovaginal candidiasis
Tinea infection

Tindakan
Fungicidal:
Mengubah ketelapan cell
membrane fungus.
Mengubah proses
metabolism RNA & DNA
fungus.
Kemudian memusnahkan sel
tersebut.

Dose (tablet)
Skin infections:
Apply sparingly & rub gently
onto affected area once daily
or bd
Continue for 10 days after
lesion have healed

 Vaginal infections:
Apply twice daily
Continue for 10 days after
lesion have healed

Kesan sampingan

Irritation
Burning
Dermatitis
Rash
Vaginal Burning

6. Miconazole Nitrate 2%
powder (Daktarin)
Category: A

Indication
Tinea infection

Dose (tablet)
Skin infections:
Dust powder aver anfected
area once daily or bd

Kesan sampingan
Irritation
Burning

Contraindication
Allergic to Miconazole
Children < 2 yr

Cautious
Pregnancy
Lactation

Interaction
Not found

7. Nystatin 500 000 unit

tablet (Mycostatin)
Category: B

Indication
Oropharyngeal candidiasis
Oral candidiasis
Intestinal candidiasis

Tindakan
Fungicidal & Fungistatic:
Bergabung dengan sterol
dalam cell membrane
fungus.
Menyebabkan perubahan
dalam ketelapan membrane.
Kemudian memusnahkan sel
tersebut.

Dose
Adult:
500 000 units q 6 hr
Severe infections: doubled

Peads:
100 000 500 000 units q 6 hr

8. Nystatin 100 000 unit/ml

suspension (Mycostatin)
Category: B

Indication
Cutaneous candidiasis

Dose
Newborn:
50 000 100 000 units/day

Peads up to 5 yr:
100 000 units q 6 hr

Peads 6-12 yr & adult:

500 000 units qid

Kesan sampingan

Nausea
Vomiting
Diarrhea
Rash
Local Irritation

Contraindication
Allergic to Nystatin

Cautious
Pregnancy
Lactation

Interaction
Not found

9. Nystatin 100 000 unit/g

cream/ ointment
(Mycostatin)
Category: B

Indication
Cutaneous candidiasis

Dose
Skin infection:
Apply onto affected area bd/ as
required
Continue for 10 days after
healing

Nail infections:
Cut nail as short as possible
Apply once daily until new nail
grows

Kesan sampingan
Local Irritation

Contraindication
Allergic to Nystatin

Cautious
Pregnancy

Interaction
Not found

10. Ketoconazole (Nizoral)

Category: A

Indication
Tinea infections
Candidiasis

Tindakan
Fungicidal & Fungistatic:
Menghalang sintesis
ergosterol (bahan asas cell
membrane fungus).
Menyebabkan perubahan
dalam ketelapan membrane.
Kemudian memusnahkan
sel tersebut.

Dose
Tinea infections:
200mg/day (for 14 days) PO
After food

Nail Infections:
200-400mg/day (6-12 months)
Max: 400mg/day

Kesan sampingan

Headache
Dizziness
Hepatoxicity
Pruritus
Thrombocytopenia
GI disturbances

Contraindication
Allergic to Amphotericin
Liver/ Renal dysfunction

Cautious
Pregnancy
Lactation

Interaction

Antacids
H2 receptor antagonist
Alcohol
Warfarin
Rifampicin
Phenytoin

11. Amphotericin B Inj

(Fungizone)
Category: A

Indication
Systemic fungal infections

Tindakan
Fungicidal & Fungistatic:
Bergabung dengan sterol
dalam cell membrane
fungus.
Menyebabkan perubahan
dalam ketelapan membrane.
Kemudian memusnahkan
sel tersebut.

Dose
Adult:
0.25mg/kg/day IV infusion
Gradually increase to
1mg/kg/day (if tolerated)
Max severe cases: 1.5mg/kg/day
or alternate days

Peads / neonates:
Lower doses

Kesan sampingan

Headache
Fever
Anorexia
GI disturbances
Anemia
Liver failure

Contraindication
Pregnancy

Cautious
Renal
impairment

Interaction
Corticosteroids
Antineoplastics

12. Amphotericin B eye

drops
Category: A

Indication
Infeksi fungus pada mata
(cornea)

Dose
1 drop hourly/ every 2 hours

Kesan sampingan

Headache
Nausea & Vomiting
Anemia
Thrombocytopenia

Contraindication
Allergic to drug

Cautious
Renal
impairment

Interaction
Digitalis
Neuromuscular agents

Pemerhatian
Buat kultur bagi menentukan
fungus penyebab.
Observe urine output
nephrotoxicity/renal toxicity

 Observe BUN, bilirubin &

elektrolite hepatoxicity
Perhatikan kesan sampingan
mual, muntah, sakit kepala,
phlebitis dan hipokalaemia

Nasihat
Mengambil dos mengikut
arahan doktor (dos & masa
yang ditentukan).
Elakkan mengambil alkohol,
mengendali alatan berbahaya
ketika dalam rawatan
ketoconazole.

Soala
n
Berikan definisi Anti-Fungus?

1.
2. Terangkan cara tindakan umum
anti-fungus?
3. Senaraikan ubat anti-fungus
beserta dengan cara tindakan
spesifik?
4. Nyatakan kesan sampingan dan
kontraindikasi ubat anti-fungus?