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TOPICAL ANTIFUNGAL THERAPY
Nystatin is a polyene macrolide much like amphotericin B. It is too toxic for parenteral administration and is only used topically.
Nystatin is currently available in creams, ointments, suppositories, and other forms for application to skin and mucous membranes. It is not absorbed to a significant degree from skin, mucous mem-branes, or the gastrointestinal tract. As a result, nystatin has little toxicity, although oral use is often limited by the unpleasant taste.
Nystatin is active against most Candida sp and is most com-monly used for suppression of local candidal infections. Some common indications include oropharyngeal thrush, vaginal can-didiasis, and intertriginous candidal infections.
The two azoles most commonly used topically are clotrimazole and miconazole; several others are available (see Preparations Available). Both are available over-the-counter and are often used for vul-vovaginal candidiasis. Oral clotrimazole troches are available for treatment of oral thrush and are a pleasant-tasting alternative to nystatin. In cream form, both agents are useful for dermatophytic infections, including tinea corporis, tinea pedis, and tinea cruris. Absorption is negligible, and adverse effects are rare.
Topical and shampoo forms of ketoconazole are also available and useful in the treatment of seborrheic dermatitis and pityriasis versicolor. Several other azoles are available for topical use (see Preparations Available).
Terbinafine and naftifine are allylamines available as topical creams . Both are effective for treatment of tinea cruris and tinea corporis. These are prescription drugs in the USA.
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