Posts: 3,675,935
Threads: 734,343
Joined:
Sep 2021
Reputation:
5
Which of the following statements concerning antifungal
therapy is correct?
A) Dose-related hepatotoxicity is a complication of ketoconazole treatment.
B) Clotrimazole is the preferred imidazole for the
treatment of vaginal candidiasis.
C) Oral fluconazole may be used as primary therapy
in patients with aspergillosis.
D) Flucytosine plus amphotericin B is useful in cases
of refractory hepatic candidiasis.
E) The treatment of candidal hepatitis frequently requires 2 weeks of daily intravenous administration of amphotericin B.
Posts: 3,675,935
Threads: 734,343
Joined:
Sep 2021
Reputation:
5
The answer is D.
Successful treatment of antifungal infections is not as straightforward as that for bacterial
infections.
The topical imidazoles that are available for the treatment of vaginal candidiasis include
miconazole, clotrimazole, and butoconazole; the triazole terconazole is also available. No
substantial difference in efficacy or toxicity among these agents has been noted.
Ketoconazole therapy is useful in the treatment of several fungal infections, including
esophageal candidiasis, but is associated with several dose-related toxicities, including
anorexia and inhibition of steroidogenesis in the adrenal cortex or gonads; hepatotoxicity is
idiosyncratic. Fluconazole is an orally administered triazole that may have activity in candidal
infection and is useful in a prophylactic role in allogeneic bone marrow transplant patients.
Amphotericin B itself is a difficult drug toadminister because of frequent toxicities, including
azotemia, anemia, hypokalemia, nausea, anorexia, weight loss, phlebitis, and
hypomagnesemia. Nonetheless, amphotericin B is indicated for the treatment of invasive
infections such as candidal hepatitis. Given a daily dose of about 0.5 mg/kg and the
requirement that at least 2 g of the drug should be given in this situation, prolonged therapy
is required. Flucytosine, a synthetic oral drug converted to the antimetabolite 5-FU in the
fungal cell, may aid in the treatment of refractory invasive candidal disease that is not
responsive to amphotericin B alone. Flucytosine is not substituted for, but instead is added
to, amphotericin B. Patients on flucytosine should be monitored carefully, since this drug
may be myelosuppressive.
