Azole drugs

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A number of RCTs have investigated the effect of newer azolic drugs in different cutaneous candidiasis variants. One RCT compared sertaconazole 1% and 2% cream in 10 patients, who used each for 28 days. Clinical, microscopic and microbiological parameters were evaluated. The cure was total for 19 out of the 20 patients, demonstrating high efficacy. There were no relapses of infection in any of the cured patients. No local or general effects were recorded during this trial.17

Another RCT enrolled 60 patients with culturally proven dermatophytosis (47 patients) or cutaneous candidosis (13 patients) in a doubleblind, randomised study to compare the efficacy and tolerability of flutrimazole 1% cream with ketoconazole 2% cream, applied once daily for 4 weeks. Both groups of patients and distribution of target lesions were similar. The clinical results at the end of treatment were similar in both groups. The proportion of patients with negative microscopy and culture after 4 weeks of treatment was 70% in the flutrimazole group and 53% in the ketoconazole group; seven

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ketoconazole-treated patients (23%) compared with two flutrimazole-treated patients (6-6%) remained asymptomatic carriers (clinically cured with positive cultures).18

A larger recent RCT included infants age 2-13 months with diaper rash who were treated with either 0-25% miconazole nitrate (101 patients) or ointment base (101 patients) for 7 days. Both treatment groups improved, but patients receiving miconazole had significantly fewer rash sites and lower mean total rash scores on days 5 and 7 (P<0-001). In the miconazole group, improvement was greatest among those with moderate or severe diaper dermatitis at baseline and among patients whose baseline rashes were positive for C. albicans. Treatment with miconazole was as safe as with ointment base alone.19

An experimental study using an ex vivo system to evaluate fungal growth on stratum corneum strippings found a good antifungal effect of itraconazole whereas terbinafine had only marginal activity on Candida20

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