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Candidiasis (1 of 11)

Candidiasis (1 of 11)

(1 of 11)

1 Patient presents w/ signs & symptoms suggestive of candidiasis

2 DIAGNOSIS • Please see Invasive No Is candidiasis confi rmed Candidiasis disease non-invasive? management chart for further information

Yes

CUTANEOUS & MUCOSAL CANDIDIASIS • Skin • • • Oropharyngeal • Esophageal • Intra-abdominal • Vulvovaginal • Chronic mucocutaneous candidiasis

A MIMS Pharmacological therapy ©

Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS.

B55 © MIMS 2019 CANDIDIASIS • • Candidiasis Mucocutaneous Chronic • • • Vulvovaginal • • Intra-abdominal • Esophageal • Oropharyngeal Candidiasis Mucosal • • Paronychia &Onychomycosis • • Skin Candidiasis Cutaneous • • • • • Esophageal • • • Oropharyngeal Candidiasis Mucosal • Paronychia &Onychomycosis • Skin Candidiasis Cutaneous • Signs: Alopecia, esophageal stenosis, disfi stenosis, esophageal Alopecia, hands&nail ofthe lesions face, scalp, guring Signs: &persistent aprotracted what courseby despite isusuallyadequate therapy hair&nailscharacterized ofthe skin,mucous ofdisorders that infections A group includes membranes, information Vaginosis Bacterial seeVaginitis: managementPlease disease chart Trichomoniasis, forfurther Candidiasis, &dyspareunia dysuria occasional walls, vaginal w/whiteplaques erythematous labia, tous &swollen curdlike discharge, erythema- area, sensation invaginal burning VaginalSymptoms: pruritus, vulvar discomfort, women age &postmenopauseal inchildbearing females females, patients replacement onhormone &immunocompromised patients, indiabetic Common therapy, postpubertal ofgastritis) pain(symptoms Abdominal Symptoms: leak oranastomotic perforation gastrointestinal at of sites abscess &purulentinfection abdominal ornecrotic that ofinfections peritonitis, includes group Occur inpatients that have hadrecent toaheterogenous referring orintra-abdominal events surgery abdominal &vomiting pain,nausea chest retrosternal onswallowing, ofobstruction afeeling swallowing, Painful Symptoms: Creamy white,curd-like patches &other onthe &symptoms: tongue oralmucosalSigns surfaces nail loss of onychomycosis: & symptoms Signs discolored & thickened Nail appears w/ splitting & roughening w/ occasional - Purulent material under the cuticle seen may be - that whofrequently hands inthe immerse usuallyoccurs inpersons water accompanied ofproximal painduetoswelling by &lateral nailfolds&may extend extensively under the nail ofparonychia: &symptoms Signs Well-localized ofinfl area &bright red ammation that warm becomes &intergluteal regions) moistplacesUsually (eg axillary occurs inwarm inguinal, accompanied creamy &sometimes w/ distinctborder by whiteexudate orscaling that papules ormacules confl may Erythematous be &symptoms: Signs frequently pustular pruritic, very uent, - parapsilosis, krusei Candida , Candida common glabrata, Most albicans, Candida are Candida candidiasis ofinvasive organ involvementmetastatic that superfi from ranges diseases & w/candidemia associated disease cial &mucosal toinvasive infections Candida caused Infections typical symptoms alongw/oralthrush symptoms typical To empiric therapy antifungal toanat-risk given may be avoid procedures, patient invasive w/ whopresents toinitiate onscraping isenough therapy evidence pseudohyphae ofhyphae & endoscopic appearance of whitepatches that masses show In appropriate settings, clinical Defi brushing or by endoscopy during nitive: Biopsy mucosa studies esophageal onradiologic Irregular Culture isnotspecifi mouths normal from easily grows Candida c because forms & ofhyphae, pseudohyphae stainorKOH masses Gram preparation showing stainorKOHGram sp predominantly mount Candida showing hydroxide (KOH) stainorpotassium sp Gram predominantly mount Candida showing the diff tohelp identify are used exams Lab erent toantifungals sp&susceptibility Candida plate exposed toinfection plate exposed the from proximal nailplate cuticle nailfold&nail separates which aspace leaves between In chronic cases, management information disease chart seeInvasive forfurther Please Candidiasis 1

© CLINICAL FEATURES OF CANDIDAL INFECTIONS sp are major causes of morbidity & mortality causing diverse spectrum of clinical ofclinical spectrum causing ofmorbidity diverse sp are &mortality major causes Candidiasis (2of11) 2 DIAGNOSIS

B56 MIMS © MIMS 2019 CANDIDIASIS • • • • Candidiasis Mucocutaneous Chronic • • Vulvovaginal • Intra-abdominal (Cont'd) Candidiasis Mucosal • B(AmB) Amphotericin • • • • • • • • • • • • • - Oral therapy may start after 10 days of IV therapy Oraltherapy 10days may ofIV after start - - Treatment onextent duration depends ofinvolved organs Premature discontinuation therapy ofantifungal may torecurrent infection lead Patient’s agents toantifungal exposure prior - Available inthe ofthe patient given ofuse drug knowledge population - that Presence oforgan wouldaff dysfunction clearance drug ect - Relative toxicity drug - Physician’s isolate ofthe susceptibility infecting &/orantifungal ofthe knowledge - Patient’s status clinical - agent, anantifungal considerWhen factors: choosing the following KOH Culture ofinvolved areas/organs, &biopsy information Vaginosis Bacterial seeVaginitis: managementPlease disease chart Trichomoniasis, forfurther Candidiasis, hydroxide saline &10%potassium Confi pH(4-4.5)inawet-mount orhyphae &anormal presence by ofyeast preparationrmed w/theof use of mucosal foldsinthe duodenum seen &jejunum may be also &thickening whiteplaques Single ormultiple ulcerations onendoscopy; inulcer containing beds deep Candida Effi cacious for Has broad antifungal activity against most Candida most against activity broad antifungal Has hepatic dysfunction formoderate tosevere dosage reduction requires w/Candidiasis patients suspected empiricPreferred treatment intensive innon-neutropenic unit(ICU) care events adverse w/less candidiasis invasive concentrations effi minimumW/ low good inhibitory sp,which provides forCandida & esophageal against cacy therapy toazole unresponsive candidiasis oresophageal Alternative agents forpatients w/oropharyngeal Caspofungin, Eg , alternative treatment as Used inpatients whoare intolerant w/other agents antifungal - are contraindicated formulas where lipid-associated the may infection onlycandidal be candidiasis Urinary infection C glabrata Topical analternative treatment as optionagainst isused cream formulation when combined w/Flucytosine Treatment candidiasis oresophageal oropharyngeal alternative forpatients w/-refractory in appropriate dosages eff Amphotericin toxic B]are butas less liposomal Amphotericin Bdeoxycholate as (AmB-d)when used ective formulationsLipid [eg Amphotericin BlipidcomplexAmphotericin Bcolloidal (ABCD), dispersion (ABLC), Primarily used in combination w/ AmB w/ more refractory infections such as incombination infections used w/ AmBw/more refractory Primarily Occasionally used for symptomatic urinary tract candidiasis duetoFluconazole-resistant Cglabrata tractcandidiasis forsymptomatic urinary used Occasionally candidiasis &Fluconazole-resistant& endophthalmitis, vulvovaginal Cglabrata after the fiafter culture blood rst negative duration agents 14days oftherapy antifungal shouldbe In patients w/systemic candidemia, w/documented slow theslow pace ofresponse ofAmphotericin potentially B&thus reduce will delivery formulas thatIt the lipid-associated istheorized

© well-documented signifi buthas Candida cant toxicity Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing B PHARMACOLOGICAL THERAPY PRINCIPLES OF THERAPY 2 DIAGNOSIS (CONT'D) Candidiasis (3of11)

B57 MIMS species w/the exception ofCkrusei species Candida endocarditis, meningitis meningitis endocarditis, © MIMS 2019 2 1 Serious hepatotoxicity may occur w/ the use of oral . Please see Dosage Guidelines formore Dosage information. see hepatotoxicity may Please Serious occur w/the oforalKetoconazole. use Vaginosis management Bacterial : information. forfurther chart see disease Trichomoniasis,Please Candidiasis, • • Isavuconazole TriazoleOther • • • • Posaconazole • Itraconazole • • • • • Fluconazole Triazoles Isavuconazole did not meet criteria for noninferiority when compared fornoninferiority criteria toanechinocandin Isavuconazole didnotmeet ofthe analysis recentlyIt preliminary by issuggested completed international that double-blindtrial sp Candida against activity in vitro w/good triazole Recently expanded-spectrum approved notaccumulate itdoes inthe as inactiveform urine candidiasis forurinary used Should not be &Fluconazole-resistant, Voriconazole-susceptible Ckrusei by Cglabrata oraltherapy caused inpatients step-down infection w/candidal as formucosalUsed candidiasis &invasive candidiasis Fluconazole esophageal against activeas As candidiasis &esophageal Alternative treatment oropharyngeal forFluconazole-refractory determined tobe yet has infections agent candidal role ininvasive A useful &mucosalbutits fordermatologic infections candidal candidiasis ororopharyngeal chronicRecommended therapy suppressive forpatients vulvovaginal w/recurrent esophageal, sp azole-resistant Candida by analternative treatment as Used forpatients whoare w/no recent notcolonized &those toazole exposure Cparapsilosis against than butbetter echinocandins toAnidulafungin Inferior Highly eff forthe treatmentective ofsuperfi infections candidal cial &invasive Appropriate initialtherapy adultpatients as formost Vulvovaginal candidiasis Esophageal Oropharyngeal Candidiasis Mucosal candidiasis Chronic mucocutaneous Skin &paronychia Candidiasis Cutaneous Onychomycosis ieo addlIfcinAtfna fCoc AlternativeAntifungalDrugs Antifungal ofChoice Site ofCandidalInfection

© RECOMMENDED SITE-SPECIFIC ANTIFUNGALTHERAPY Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not B Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing PHARMACOLOGICAL THERAPY (CONT’D) 1 AmB-d (oral suspension/IV) or (IV) or Fluconazole (oral/IV) Posaconazole (oral suspension) Itraconazole (oral or solution) Fluconazole (oral) or disease: For tosevere moderate buccal) Miconazole (mucoadhesive or (troches) Clotrimazole For milddisease: Fluconazole (oral) Terbinafine (oral) Itraconazole (oral) Polyene (topical) antifungal or (topical) Azole Topical agents Candidiasis (4of11)

B58 MIMS Voriconazole (oral) Posaconazole (oral or suspension) Itraconazole (oral or solution) Echinocandin (IV) Echinocandin or AmB-d (oral suspension/IV) Voriconazole (oral) or disease: For tosevere moderate (suspension/pastilles) For milddisease: Ketoconazole (oral)Ketoconazole Itraconazole (oral) or Griseofulvin (oral) Griseofulvin Fluconazole (IV/oral) - 2 © MIMS 2019

CANDIDIASIS CANDIDIASIS Ketoconazole Clotrimazole Imidazoles Terbinafi ne Allylamine Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © resolved has infection active fungal Continue treatment until 24hrly 200-400 mgPO mucocutaneous: Chronic improvement day clinical x7-14days after orloz10 mgtroches 4-5x/ Oropharyngeal: 24hrly x6-12wk 250 mgPO Onychomycosis: 24hrly x2-4wk 250 mgPO Cutaneous: Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage ANTIFUNGALS (SYSTEMIC) Dosage Guidelines Candidiasis (5of11)

B59 MIMS • • • • Instructions Special • Reactions Adverse • Reactions Adverse • • • • Instructions Special • Reactions Adverse Use w/ caution inpatients w/adrenal insufficiency course Monitor LFTs treatment &wklyduring at baseline disease inpatientsContraindicated w/acuteorchronic liver - Carefully consider Carefully the benefi potential against ts - therapies are nottolerated orunavailable when other infection fungal Use onlytotreat serious rarely(high dose), gynecomastia] &adrenal[inhibition oftestosterone steroid synthesis somnolence); Other eff dizziness, (headache, ects eff CNS alopecia); rash, pruritus, angioedema, ects effhepatotoxicity); Dermatological (urticaria, ects GI eff (N/V,ects pain,serious abdominal Other eff mental depression) (dysuria, ects GI eff GIdisturbance); liver enzymes, (increased ects inpatients w/renalReduce doses impairment Use w/caution inpatients w/psoriasis oraltherapy starting before (LFTs) tests Perform liver function inallpatients inpatients notuse w/hepatic impairmentDo (headache) effDermatological Other eff urticaria); (rash, ects ect disturbance liver dysfunction); oftaste, GI eff (N/V,ects or pain,loss abdominal diarrhea, risks oftherapy risks Remarks © MIMS 2019 Itraconazole Fluconazole Triazoles Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © 24hrly 100-200 mgPO mucocutaneous: Chronic 100-200mg12hrly x2-3wk soln: Oral Esophageal: 12 hrly x2-3wk 200mg/day soln: 24hrly ordivided Oral Cap: cases): resistant Fluconazole- (including Oropharyngeal mth repeat mthlyx2-3 mg PO200 hrly xwk, 12 1 Onychomycosis: 4-12 mth 150mgwklyfor by followed 10-14 days PO Inductiontherapy for Recurrent: 72hrly 150mgPO acute: Severe, singledose Uncomplicated: 150mgPO Vulvovaginitis: mycological response & onclinical based shouldbe Duration 24hrly x14-30days 50-100 mgPO mucocutaneous: Chronic weekly 3times 100-200 mgPO therapy: suppressive chronic esophagitis, For recurrent 24hrly 400 mgIV Patient therapy: tolerateoral whocannot or 24 hrly x 21 days 24hrly x1day200 mgPO then 100mgPO x14-30days50-100 mg/day or PO : Esophageal weekly 3times 100mgPO infection: Recurrent 24 hrly x 7-14 days onday 1then200 mgPO 100-200mgPO Oropharyngeal: Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not 100-200 mg PO 24hrly x15days 100-200mgPO Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing ANTIFUNGALS (SYSTEMIC)(CONT’D) Dosage Dosage Guidelines Candidiasis (6of11)

B60 MIMS • • Instructions Special • Reactions Adverse • Instruction Special • Reactions Adverse drink (egdrink cola) w/anacidic theadministering drug by improved may be absorption In patients w/hypochlorhydria, renal insuffi ciency hepatic impairmenthepatic failure, & Use w/ caution inpatients at for risk treatment) w/prolonged hypokalemia edema, Other effangioedema); (alopecia, ects eff urticaria, rash, (pruritus, ects Dermatological dizziness); (headache; cholestatic eff jaundice); CNS ects hepatitis, liver enzymes, increased constipation, diarrhea, nausea, GI eff pain, abdominal (dyspepsia, ects hepatic impairment Use w/caution inpatients w/renal & liver enzymes) elevated flatulence, N/V, disturbance, taste GI eff pain,diarrhea, (abdominal ects Remarks © MIMS 2019

CANDIDIASIS Voriconazole Posaconazole Triazoles (Cont’d) Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All symptoms resolve symptoms 7daysmin 14days after &at least 12hrly x 100mgPO dose: Maintenance by followed 12hrly x24hr 200mgPO dose: Loading Patient <40kg: 12hrly 200mgPO dose: Maintenance by followed 12hrly x24hr 400mgPO dose: Loading Patient ≥40kg: Esophageal: 300 mg PO 24 hrly 24hrly 300mgPO tablet: Extended-release or 12hrly x14-21days 400mgPO disease): (Fluconazole-refractory Esophageal © oralintake limited 6hrly w/ 12hrly or200mgPO 400 mgPO candidiasis: oropharyngeal Refractory 24hrly x13days 100mgPO by day followed onthe 24hrly 1st loadingdose 200 mgPO 24hrly upto28days or PO 12hrly x3days then400 mgPO 400mg Oropharyngeal: Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing ANTIFUNGALS (SYSTEMIC)(CONT’D) Dosage Dosage Guidelines Candidiasis (7of11)

B61 MIMS • • • Instructions Special • Reactions Adverse • • Instructions Special • Reactions Adverse reported have reactions been photosensitivity Avoid sunlight treatment during as avoided shouldbe machinery oroperating driving disturbances, For patients aff visual by ected impairment Use w/caution inpatients w/hepatic edema) peripheral fever, headache, disturbances, rashes, pain); Other eff (visual ects GI eff (N/V,ects abdominal diarrhea, Monitor hepatic function arrhythmiacardiac Use w/caution inpatients at for risk fever) skin,fatigue, dry Otherparesthesia); eff pain, (back ects somnolence, insomnia, dizziness, eff mouth); CNS dry (headache, ects fl anorexia, pain, dyspepsia, atulence, GI eff (N/V,ects abdominal diarrhea, Remarks © MIMS 2019

CANDIDIASIS Micafungin Caspofungin Anidulafungin Echinocandins Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed improvement clinical x14-21days150 mg/day after IV disease): (severe/refractory Esophageal improvement afterclinical days IVx7-14 mg/day 100 disease): (severe/refractory Oropharyngeal 7-14 days 1hr24hrly over for infusion IV 50 mgslow Esophageal: 50 mg slow IV infusion over 1hr24hrly over infusion IV 50 mgslow disease): (severe/refractory Oropharyngeal improvement clinical 14-21 days after 24hrly x 50mg/day IV Followed by: onday 1 100mgIV dose: Loading Esophageal: improvement clinical 7-14 days after 24hrly x 100mg/day IV Followed by: onday 1 200mgIV dose: Loading disease): (severe/refractory Oropharyngeal & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing ANTIFUNGALS (SYSTEMIC)(CONT’D) Dosage Dosage Guidelines Candidiasis (8of11)

B62 MIMS • • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse • • • Instructions Special • Reactions Adverse impairment patients w/renal orhepatic in Monitor renal &hepatic function hepatic impairment Use w/ caution inpatients w/renal or site) around infusion fever,headache, venous complications warmth); Other eff (flects ushing, sensation of pruritus, swelling, effDermatological facial (rash, ects GI eff (N/V,ects LFTs); increased w/ hepatic impairment inpatients toreduce doses May need site) infusion fever, venous complications around fl swelling, (facial headache, ushing, sensation ofwarmth); Other eff ects effDermatological pruritus, (rash, ects GI eff (N/V,ects LFTs); increased patients abnormal LFTs whodevelop Monitor LFTs therapy during &in occur reactions Discontinue ifanaphylactic use inj bolus as administered Not tobe sensation ofwarmth) pruritus, swelling, facial (rash, eff site);Dermatological infusion ects fever, venous complications around Other eff (flects headache, ushing, GI eff (N/V,ects LFTs); increased Remarks © MIMS 2019

CANDIDIASIS deoxycholate Polyenes Nystatin Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed after clinical improvement clinical after 6hrly x7-14days 100 mg/mLsuspPO 1mLof cases: Itraconazole-resistant 24hrly 0.3mg/kgIV Refractory: Oropharyngeal: treated x 48 hr more after improvement x48hrmore after treated patient 7-14days; shouldbe Duration: immunocompromised patients in used may be Higher doses 6hrly possible in the longas mouth as 1 mLof100,000U/mLoralsuspretained Oropharyngeal: improvementclinical x14-21days0.3-0.7 mg/kg/day after IV : cases) (severe/refractory Esophageal & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing ANTIFUNGALS (SYSTEMIC)(CONT’D) Dosage Dosage Guidelines Candidiasis (9of11)

B63 MIMS • • • • • Instructions Special • • Reactions Adverse • • Instructions Special • Reactions Adverse dosage regimens for individual preparations forindividual dosage regimens the taken nottoconfuse shouldbe Care eff adverse infusion-related ects to avoid slowly & vein drug irritation Infuse - If blood urea nitrogen (BUN) &creatinine nitrogen urea (BUN) Ifblood - & hematologic status electrolytes serum renal function, function, Monitor patient forchanges inliver Amphotericin Bdose to prior antihistamines given may be To & antipyretics reduce febrile reactions, patient treatment starting before the &observe dose to administer atest Although israre, anaphylaxis itisadvisable allpatientsNephrotoxicity occurs inalmost painat& joint pain,malaise, inj site) fever, headache, muscle loss, hearing chills, Other eff tinnitus, ofvision, (blurring ects thrombophlebitis at(anemia, inj site); eff Hematological hypomagnesemia); ects eff Metabolic reactions); (hypokalemia, ects eff fl (rashes, ects anaphylactoid ushing, Dermatological arrhythmias); hypotension, effdisorders); CVS (hypertension, ects liver GIbleeding, anorexia, cramps, GI eff (N/V,ects abdominal diarrhea, occurs Discontinue &sensitization ifirritation mycoses fortreating systemic used Should notbe reported) have been effDermatological &urticaria (rashes ects GI eff (N/V,ects oralirritation); diarrhea, formulation Amphotericin Borchange tolipid of the dose decrease rises, (Cr) levels Remarks © MIMS 2019

CANDIDIASIS 3 2 1 For vaginal preparations used for the treatment for vulvovaginal candidiasis, please see Vaginitis: Trichomoniasis, Candidiasis, Bacterial Bacterial Vaginitis: see Trichomoniasis, please Candidiasis, For forthe candidiasis, treatment preparations used vaginal forvulvovaginal Various combinations the forspecifi latest MIMS ofMiconazole see are available. Please information. c prescribing Various the forspecifi latest MIMS combinations see are available. ofClotrimazole Please information. c prescribing Vaginosis information. forfurther Nystatin Polyene Tioconazole Sertaconazole Miconazole Ketoconazole Isoconazole Fenticonazole Econazole Ciclopirox olamine) (Ciclopiroxolamine, Ciclopirox Others Naftifi ne Allylamines Clotrimazole Bifonazole Imidazoles 1%soln, Terbinafi ne Povidone-iodine Drug 3 2 Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not cream 100,000 u/g Apply 12-24hrly lotion 1% cream, 2% cream gel cream, soln, 2% powd, Apply 12-24hrly soln cream, 2% gel, 1% cream Apply 12-24hrly spray 2% cream, 1% cream spraycream, lotion, soln, 1% powd, %cemApply 12hrly 1% cream 1% cream %cemApply 24hrly 1% cream Apply 12-24hrly 1% cream spraycream, Strength Available Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing 1 ANTIFUNGALS (TOPICAL) Dosage Guidelines Candidiasis (10of11) days Apply 6-24hrly for14 Apply 12-24hrly Apply 12hrly Apply 12-24hrly Apply 12-24hrly Apply 8-12hrly Apply 24 hrly Apply 24 Apply 12-24hrly Dosage

B64 MIMS • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse Duration of therapy: 2-4wk oftherapy: Duration israre irritation Local Duration of therapy: 2-4wk oftherapy: Duration pain burning, redness, Pruritus, Duration of therapy: 2-4wk oftherapy: Duration itching) stinging, effDermatological (redness, ects Duration of therapy: 2-4wk oftherapy: Duration pruritus) erythema, mildburning, reactions, &hypersensitivity irritation local effDermatological (occasional ects Remarks © MIMS 2019

CANDIDIASIS CANDIDIASIS ioaoe0.2%oralgel Miconazole gluconate Chlorhexidine Drug Drug PREPARATIONS FORORALULCERATION &INFLAMMATION Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All

© mouthwash 0.12%, 0.2% Available Available Strength Strength Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Please see the end of this section for the reference list. reference the for section this of end the see Please OROPHARYNGEAL ANTI-INFECTIVES resolution clinical 48 hrafter Continue treatment for 1 min12hrly mouth w/10-30mLfor Rinse candidiasis: Oral area 6hrlyarea Apply 2.5mLtoaff ected >2yr: &childn Adults 6 hrly 1.25 mLtoaff area ected 6-24mth: ApplyInfants Dosage Guidelines Candidiasis (11of11) Dosage Dosage

B65 MIMS • Instructions Special • Reactions Adverse • • • • • Instructions Special • Reactions Adverse Avoid in patients w/hypersensitivity initial use) sensation on oftheburning tongue transientdesquamation, parotitis, GI eff alteration, (taste oral ects dysfunction in patientsContraindicated w/liver usingthe gelbrush dentalRemove at night prostheses & ofsymptoms resolution Continue after aweek forat least young children & ininfants especially smaller parts in divided shouldbe throat dose &full at applied theShould not be back ofthe possible inthe longas but kept mouth as immediately, swallowed Should not be treatment, diarrhea) GI eff (N/Vw/long-term ects Remarks Remarks © MIMS 2019

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