tract mucosa. Phenazopyridine is excreted in the urine where it exerts a topical anesthetic effect on the mucosa of the urinary tract. It is contraindicated where renal insufficiency exists. Phenazopyridine imparts a bright red or orange color to the urine and the patient should be made aware of this fact.
USUAL DOSE.— 200 mg three times daily after meals.
Bacitracin
ACTION AND USE.— This bactericide is effective against a wide variety of organisms. Its mode of action is the inhibition of bacterial cell wall synthesis. It is not effective against most aerobic gram-negative bacilli and is employed locally by topical application in ointment form.
ANTIFUNGAL
Antifungal agents inhibit or suppress the growth systems of fungi, dermatophytes, or Candida. Antifungal have not been developed to the same degree as antibacterial agents. Most fungi are completely resistant to the action of chemicals at concentrations that can be tolerated by the human cell. Since there are only a few available for internal use, most antifungal agents are topical. The agents that are available for systemic use generally produce hepatic or renal dysfunction or other serious side effects; because of this, systemic antifungal should be limited to serious or potentially fatal conditions. When using oral or parenteral antifungal agents, provide concomitant therapy with topical preparations.
Nystatin (Mycostatin)
ACTION AND USE.— Nystatin is primarily used in the treatment of candidal infections. It is fungicidal and fungistatic against a wide variety of yeasts and yeast-like fungi and most often used in the treatment of candidiasis. It is sometimes used concurrently with tetracycline to suppress the overgrowth of Candida in the bowel.
USUAL DOSE.— Nystatin is available as a cream, powder, oral tablets, vaginal tablets, or oral suspension. The cream or powder should be applied two or three times daily as indicated by clinical response; one or two oral tablets three times daily until 48 hours after clinical cure; vaginal tablets one daily for 2 weeks; and the oral suspension 2 to 4 ml four times daily held in the mouth for as long as possible before swallowing.
Griseofulvin (Gris-Peg, Fulvicin)
ACTION AND USE.— Griseofulvin is a fungistatic agent used in the treatment of fungal infections of the nails, hair, and skin. It is generally reserved for chronic infections that have not responded to topical therapy alone. Because treatment may last for several months, the patient should be instructed to follow the treatment regimen even though symptoms may abate. Inclusion of topical therapy is a must for effective elimination of the infection. Griseofulvin is not indicated for the treatment of superficial fungal infections that can be controlled by topical antifungal. Because of its toxicity, patients should have periodic evaluations of hepatic and renal function. Griseofulvin is contraindicated in patients with hepatic dysfunction.
USUAL DOSE.— 500 mg to 1 g daily as either a single dose or two equally divided doses.
Miconazole Nitrate (Monistat)
ACTION AND USE.— Miconazole nitrate is a synthetic antifungal that inhibits the growth of common dermatophytes. Is is indicated for the treatment of cutaneous fungal infections and vulvovaginal candidiasis.
USUAL DOSE.— For topical preparations, the cream should be applied to the affected area twice daily. For vaginal infections, either the cream or the suppository should be inserted daily at bedtime for 7 days.
Undecylenic Acid (Desenex)
ACTION AND USE.— This is a fatty acid antifungal, available in ointment, dusting powder, solution, and spray. It is used primarily in the treatment and prevention of tinea pedis (athlete’s foot) and is often compounded with zinc to act as an astringent.
FOR TOPICAL USE.— Apply two to four times daily between the toes and on the affected areas.
