Fungal Infections (Candida)
Although most cases of candida infection are treated with some type of antifungal agent, the formulation of the medication (e.g., pills, ointment, suppositories, or powder) will largely depend on the location and clinical presentation of the infection (Pammi 2012; Ferri’s 2012).
Mild oral candidiasis can be treated with either clotrimazole lozenges or a nystatin swish-and-swallow suspension, but may require oral fluconazole for moderate to severe and recurrent cases (Kauffman 2012). An emerging treatment for oral candidiasis involves the use of mouthwash containing silver nanoparticles (SN). Although this approach requires more investigation to include safety and efficacy, it may hold therapeutic potential in the near future (Monteiro 2012).
Candidiasis of the skin is most often managed with topical antifungal agents of the azole class (e.g., bifonazole or ketoconazole) (Katoh 2009). People with candidiasis of the skin should also keep the skin as dry as possible and, if appropriate, use antifungal mouth rinses or shampoos.
Fungal infections of the finger/toe nail plate (e.g., onychomycosis) are typically treated with both topical and systemic antifungals. However, long-term cure and recurrence rates, as well as costs associated with these treatments, are often unsatisfactory. For this reason, researchers have studied the effects of laser therapy for the treatment of onychomycosis; they found that this technology is capable of inhibiting the growth of the fungus on nail samples (Manevitch 2010). In severe cases that do not respond to drug therapy, surgical removal of all or part of the nail plate may be considered (Singal 2011).
Vaginal candida infections can be treated with topical or oral antifungal drugs such as fluconazole or nystatin (Sobel 2012). The species of candida a woman is infected with can influence treatment response. For example, fluconazole and nystatin are both effective for the treatment of Candida albicans, but in women with non-albicans species, only fluconazole is highly effective (Rodrigues Martins 2012).
Treatment for invasive/systemic candidiasis depends on a variety of factors, but will most likely involve intravenous or oral therapy with any one of the following drug classes: polyenes, azoles, and echinocandins (Kauffman 2012d). The polyene drug amphotericin B is a very common treatment, but is hindered by considerable kidney toxicity. Therefore, newer, less toxic derivatives of the drug (e.g., liposomal amphotericin B) are a better option. The high cost of these formulations, however, can be burdensome in some circumstances (Bassetti 2011; Kauffman 2010).
The side effects of most systemic antifungal drugs are comparable and include headache, gastrointestinal symptoms (e.g., nausea and vomiting), hepatitis, kidney toxicity, and lupus-like syndromes, among others (Werth 2011; Kauffman 2011;Khan 2012).