INDICATIONS:

• Nystatin (Mycostatin, Nilstat), Clotrimazole (Mycelex Troche):
  • Treatment of oropharyngeal candidiasis.

• Fluconazole (Diflucan), Itraconazole (Sporanox), Ketoconazole (Nizoral):
  • Treatment of oropharyngeal candidiasis.
  • Treatment of fungal infections of the skin, hair and nails.

• Griseofulvin microsize (Grifulvin V):
  • Treatment of fungal infections of the skin, hair and nails.

DOSE:

• Nystatin (Mycostatin, Nilstat):
  • Infants 1 - 2 ml 4 times a day.
  • Children 4 - 6 ml 4 times a day.
  • One-half the dose should be placed in each side of the mouth. In infants and small children the lesions may be swabbed using a cotton tipped applicator dipped in the suspension.
  • The usual course of therapy is 14 days. Continue treatment at least 2 days after symptoms disappear.

• Clotrimazole (Mycelex Troche):
  • >3yrs - One troche dissolved in the mouth slowly 5 times daily.

• Fluconazole (Diflucan):
  • For candidiasis: Given once daily. Give 6 mg/kg/day (2.7 mg/lb/day) for the first dose and then 3mg/kg/day (1.4 mg/lb/day) for a total of 14 - 21 days. Maximum dose is 600 mg/day.
  • For tinea capitis: Given once daily. Give 6 mg/kg/day (2.7 mg/lb/day) for a total of 2 - 4 weeks.
  • For tinea corporis, tinea pedis and tinea cruris: Given once daily. Give 3 mg/kg/day (1.4 mg/lb/day) for 2 - 3 weeks.

• Itraconazole (Sporanox):
  • For candidiasis: Given once daily. Give 5 mg/kg/day (2.3 mg/lb/day) for a total of 2 - 3 weeks.
  • For tinea capitis: Given once daily. Give 5 mg/kg/day (2.3 mg/lb/day) for a total of 4 weeks.
  • For tinea corporis, tinea pedis and tinea cruris: Given once daily. Give 5 mg/kg/day up to 100 mg for a total of 2 weeks.

• Ketoconazole (Nizoral):
  • For candidiasis: >2 yrs - Given once daily. 3.3 - 6.6 mg/kg/day (1.5 - 3 mg/lb/day) for a total of 2 - 6 weeks.
  • For tinea capitis: Given once daily. 6.6 mg/kg/day (3 mg/lb/day) for 4 - 8 weeks.
  • For tinea corporis, tinea capitis and tinea cruris: Give 6.6 mg/kg/day (3 mg/lb/day) for 2 - 4 weeks.

• Griseofulvin microsize (Grifulvin V):
  • 10 - 20 mg/kg/day (4.5 - 9 mg/lb/day) as a single daily dose up to the adult dose of 500 mg daily.
  • The usual course of therapy varies depending on the specific type and severity of infection. For tinea corporis, tinea capitis and tinea cruris, usually 2 - 8 weeks. For tinea unguium, at least 4 - 6 months.

COST:

• Nystatin and griseofulvin are relatively inexpensive medications. Others are expensive.
• Generics available for nystatin and griseofulvin.

CAUTIONS:

• Nystatin Suspension:
  • To prevent relapse, therapy should continue for at least 48 hours after symptoms have disappeared.

• Clotrimazole, fluconazole, itraconazole, ketoconazole:
  • All can cause hepatotoxicity.

• Griseofulvin:
  • Also available as ultramicrosize tablets which have increased absorption and thus a decreased dose.
  • Skin rash, nausea, vomiting, diarrhea, photosensitivity reactions.

COMMENTS:

• Shake suspensions well before administration. Do not refrigerate.
• These drugs can also be used for other fungal infections. Dose and length of treatment depends on the infecting organism and the severity of the infection.

• Nystatin Suspension:
  • Medication can be swallowed.
  • Apply at least 30 minutes before or after a feeding.

• Griseofulvin:
  • Take for the full course of therapy.
  • Take with food or milk.

• Fluconazole, itraconazole, ketoconazole:
  • Take on an empty stomach. Food can affect absorption.
  • Pulse therapy, on 1 week, off 2 weeks for 1 - 3 pulses, has been tried successfully.

Monograph last updated: December 1st, 1999