Cutaneous Protothecosis Medication

Updated: Aug 20, 2020
  • Author: Thomas N Helm, MD; Chief Editor: William D James, MD  more...
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Medication

Medication Summary

Although not a true fungal disease, treatment with antifungals is effective and may be used in conjunction with surgical excision. When a patient shows resistance to one antifungal, susceptibility testing may be helpful to direct treatment. [21]

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Antifungal Agent, Systemic

Class Summary

These agents exert a fungicidal effect by the following mechanisms: altering the permeability of the fungal cell membrane, altering RNA and DNA metabolism, and causing intracellular accumulation of peroxide.

Itraconazole (Sporanox)

Itraconazole has fungistatic activity. It is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P-450–dependent synthesis of ergosterol, a vital component of fungal cell membranes.

Voriconazole (Vfend)

Voriconazole is a triazole antifungal agent that inhibits fungal CYP450-mediated 14 alpha-lanosterol demethylation, which is essential in fungal ergosterol biosynthesis.

Fluconazole (Diflucan)

Fluconazole is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation, which prevents conversion of lanosterol to ergosterol, thereby disrupting cellular membranes. It has little affinity for mammalian cytochromes, which is believed to explain its low toxicity. It is available as tabs for oral administration, as a powder for oral suspension, and as a sterile solution for IV use. Fluconazole has fewer adverse effects and better tissue distribution than older systemic imidazoles.

It can be used in severe or life-threatening infections in patients intolerant of amphotericin B, and it may be used for maintenance after a course of amphotericin B in coccidioidal meningitis. It penetrates well into cerebrospinal fluid. Metabolic clearance is prolonged in patients with renal dysfunction.

Amphotericin B (AmBisome)

Amphotericin B is for use in disseminated disease. It is produced by a strain of Streptomyces nodosus and can be fungistatic or fungicidal. Amphotericin B binds to sterols (eg, ergosterol) in the fungal cell membrane, causing intracellular components to leak, with subsequent fungal cell death.

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