7: Antifungals Commonly Used in Dentistry: Assessment, Analysis, and Associated Dental Management Guidelines

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Antifungals Commonly Used in Dentistry: Assessment, Analysis, and Associated Dental Management Guidelines

POLYENE AND AZOLE ANTIFUNGALS: OVERVIEW, FACTS, AND PRESCRIPTIONS

Two distinct classes of antifungal medications used in dentistry are the polyenes and the azole antifungals.

Polyene Antifungals: Mechanism of Action

Polyenes bind with ergosterol in the fungal cells and form holes, causing cell death due to the leaking out of the cell contents.

Polyene Drug Classifications

Polyene drugs include:

1. Nystatin (Mycostatin): topical and oral nystatin
2. Amphotericin B (Fungizone): oral and IV amphotericin B

Azole Drugs Classification

Azole drugs are classified as:

1. Imidazole antifungals: clotrimazole (Mycelex) and ketoconazole (Nizoral)
2. Triazole antifungals: fluconazole (Diflucan) and itraconazole (Sporanox)

Imidazole and Triazole Antifungals: Mechanism of Action and Facts

Imidazole and triazole antifungals inhibit the CYP450 enzyme, thus preventing the formation of ergosterol and fungal cell membrane synthesis.

Fluconazole and itraconazole, the newer azole antifungals, generally have fewer side effects. They are used a lot more for treatment of fungal infections in the immune-compromised patient compared to ketoconazole. They both affect the fungal cell membrane a lot more than ketoconazole. Hence lower doses are needed for optimal effectiveness.

Topical and Oral Nystatin

Nystatin Facts

The topical and oral forms of nystatin are not absorbed on ingestion and consequently are not associated with any DDIs. The oral form is used to treat oral or esophageal fungal infections. Both forms of nystatin are commonly used in HIV/AIDS patients with a low CD4 count, in patients undergoing chemotherapy, and in patients in whom azole antifungals are contraindicated. Nystatin is in Pregnancy Category B. Nystatin suspension is the drug of choice for patients experiencing xerostomia.

Nystatin (Mycostatin) Prescriptions

1. Nystatin oral suspension for oral candidiasis:
Rx: Nystatin oral suspension 100,000 units/mL.
Disp: 473mL (1 pint) bottle (14-day supply).
Sig: Use 1tsp or 5mL, qid. Rinse and hold in the mouth as long as possible before swallowing. There should be no eating or drinking for 30min after use.
Note: Nystatin suspension is also dispensed as a 60mL bottle.
2. Nystatin oral suspension for soaking of dentures/partials:
Rx: Nystatin oral suspension 100,000 units/mL.
Disp: 473mL (1 pint) bottle.
Sig: Add 5–10mL of 1:100,000 units nystatin to half cup of water and soak the dentures overnight daily for 14days. Rinse the dentures before use.
3. Nystatin pastille prescription for oral candidiasis:
Rx: Nystatin 200,000 units/pastille.
Disp: 70 pastilles.
Sig: Dissolve 1 pastille in the mouth 4–5 times/day for 14days. Do not eat for 30min after use.
4. Nystatin (Mycostatin) cream: The cream can be applied to the dentures before insertion or can be used for angular chielitis.
Rx: Nystatin 100,000 units/g.

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Jan 4, 2015 | Posted by in General Dentistry | Comments Off on 7: Antifungals Commonly Used in Dentistry: Assessment, Analysis, and Associated Dental Management Guidelines
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