Dermatologic infections- Treatment options.

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Dermatologic

Possible therapeutic alternatives

Phthiriasis (pubic lice, crabs)

Common pathogens

Permethrin (Elimite): Scabies: apply cream from to soles of feet and wash after 8-14 hours. [5% cream]. Lice (Nix rinse): saturate hair and scalp with rinse. Wash after 10 minutes.

Lindane (Kwell): Scabies: apply 30-60 ml of lotion/cream in a thin layer from the neck to the toes. Bathe and remove after 8-12 hours. Repeat treatment in 7 days if still present. Pediculosis, lice: 15-30 ml of shampoo-lather for 4-5 minutes. Rinse hair thoroughly and comb with a fine tooth comb to remove nits. May repeat in 7 days is still present.

RID, A-200 (pyrethrins, piperonyl butoxide): Lice: Apply shampoo, wash after 10 minutes. Re-apply in 5-7 days.

Crotamiton (Eurax): Scabies: apply cream/lotion from chin to feet. Repeat In 24hrs. Bathe after 48 hours. Pruritus: massage as needed. [cream/lot 10%]

Nail Infections

Terbinafine (Lamisil) 250 mg PO qd x 6weeks (fingernails) or x 12 weeks (toenails)

Itraconazole (Sporanox) 100mg PO bid or 200mg PO qd x 8 weeks (fingernails) or x 12 weeks (toenails). Pulse regimen: 200mg PO bid x 1w, for 2 consecutive months (fingernails) or 3 consecutive months (toenails)

Fluconazole (Diflucan) 150-300mg PO weekly x 6-12 months (until complete nail growth)

Tinea corporis/tinea cruris

Trichophyton rubrum

ciclopirox (Loprox Ž): Apply cream or lotion twice daily [cream/lotion 1%]

butenafine (Mentax Ž): Apply cream once or twice daily. [cream 1%]

clotrimazole (Lotrimin Ž): Apply twice daily. Supplied: [1% cream /solution /lotion]

enconazole (Spectazole Ž): Tinea: apply once daily. Candida: apply twice daily. Supplied:[1% cream]

ketoconazole: (Nizoril Ž) Tinea/candida: apply once a day Supplied: [2% cream]. Seborrheic dermatitis: apply shampoo/cream once or twice daily. Dandruff: shampoo 2 times per week.

Miconazole: Tinea/candida: apply twice a day. Supplie: [2% cream/powder/spray]

naftifine (Naftin Ž): Tinea: apply once daily (cream) or twice a day- (gel)

terbinafine (Lamisil Ž): Tinea: apply once or twice daily. Supplied: [cream 1%]

tolnaftate (Tinactin Ž): Apply twice a day. Supplied: [1% cream /powder/ gel /solution]

Antimicrobial Series
References

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Bernstein JM: Treatment of community-acquired pneumonia--IDSA guidelines. Infectious Diseases Society of America. Chest 1999 Mar; 115(3 Suppl): 9S-13S

Drug Information Handbook, 5th Ed. 1997, Lexi-Comp inc.

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Gilbert DN, Moellering RC, Sande MA. The Sanford Guide to Antimicrobial Therapy 2000. 30th ed. Hyde Park,VT: Antimicrobial Therapy, Inc.; 2000.

Gold HS, Moellering RC. Antimicrobial-drug resistance. N Engl J Med. 1996;335:1445-1453.

Gonzales R, Sande M: What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet 1995 Mar 18; 345(8951): 665-6

Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am 1997;11:551-581.

Lipsky BA, Berendt AR.Principles and practice of antibiotic therapy of diabetic foot infections.
Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S42-6.

Mufson MA.Pneumococcal Pneumonia.
Curr Infect Dis Rep. 1999 Apr;1(1):57-64.

Reese RE, Betts RF: A Practical Approach to Infectious Diseases. 4th ed. Boston: Little, Brown, and Company; 1996: 251

Stefani SD, Cadore LP, Villaroel RU, Azevedo S, Machado AL. Antibiotic Selection in the Treatment of Febrile Neutropenia: Current Approach and New Directions.
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Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med 1993;329:1328-1334.