Pityriasis%20(tinea)%20versicolor Treatment

Treatment

Pharmacotherapy

Treatment is usually effective but may have to be repeated due to recurrence of infection in susceptible individuals
- Prophylactic treatment is recommended for patients at risk of recurrence on exposure to sunlight or warm humid conditions

Skin discoloration may take several weeks to resolve after complete treatment
- If mycology is negative, persisting pale patches do not necessarily warrant additional treatment

Topical agents can be very effective & are safer than systemic medications, especially in children

Initial Therapy

May use Selenium sulfide or Ketoconazole shampoo
Antifungal cream is advised for small areas of skin involvement
- Imidazole creams may be used in both children & adults

If initial therapy fails, confirm adherence to treatment
- May consider repeat topical treatment before starting systemic therapy
Other topical agents such as Whitfield ointment, Sulfur-Salicylic acid shampoo, Propylene glycol, & Benzoyl peroxide may be considered but patient should be informed about possible adverse effects prior to use

Topical Antifungals

Used as initial treatment
Desirable properties: High efficacy, favorable adverse effects profile, fewest possible daily applications, shortest duration of therapy, low relapse rate & cost-effectiveness
Ciclopirox
- Topical application is proven effective when used twice daily for 2 weeks
Terbinafine
- Efficacy of topical application is comparable & may even surpass effect of imidazoles against tinea infections
Selenium sulfide & Zinc pyrithione
- Proven to be effective & safe; inexpensive for 1st-line therapy
- May be used as maintenance regimen (apply on the 1st and 3rd day of each month and leave on for 5 minutes before rinsing)
Imidazoles
- Highly effective, safe & fairly inexpensive
Combined steroid/imidazole agents
- High-potency steroid combination is not indicated for treating Pityriasis (tinea) versicolor due to the absence of significant inflammation in this condition & the potential of the steroid component to induce atrophy

Oral Antifungals

Indicated in cases of severe or widespread skin involvement, recurrent infections, & failure of topical therapy

Systemic Therapy

Indicated in cases of severe or widespread skin involvement, recurrent infections, & failure of topical therapy
Oral antifungal agents Itraconazole & Fluconazole are preferred
Oral Itraconazole is also used for prophylaxis of recurrences

Tackling multidrug-resistant gram-negative bacterial infections in critically ill patients: Challenging the standard approach

Dr. Asok Kurup, Dr. Kenneth Chan, 07 Dec 2020

The rising incidence of infections caused by multidrug-resistant (MDR) gram-negative bacteria has become a serious health threat and a major challenge for intensivists. Against a backdrop of high patient mortality and risk factors for infection in intensive care units (ICU), early adequate therapy is of paramount importance. At a recent Pfizer-sponsored symposium, Dr Asok Kurup, Infectious Disease Physician, Singapore presented the implications of MDR gram-negative infections in critically ill patients in Asia, while Dr Kenneth Chan, Respiratory Physician and Intensivist, Singapore highlighted the role of ceftazidime-avibactam (Zavicefta) and shared published real-world data on ceftazidime-avibactam.

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29 Sep 2021

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Spotlight on multidrug-resistant gram-negative infections: New developments for an old problem

Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021

Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.