Pharmacologic Profile

General Use

Treatment of fungal infections. Infections of skin or mucous membranes may be treated with topical or vaginal preparations. Deep-seated or systemic infections require oral or parenteral therapy. Lipid-based formulations of amphotericin employ lipid encapsulation technology designed to ↓ nephrotoxicity.

General Action and Information

Kill (fungicidal) or stop growth of (fungistatic) susceptible fungi by affecting the permeability of the fungal cell membrane or protein synthesis within the fungal cell itself.

Contraindications

Previous hypersensitivity.

Precautions

Because most systemic antifungals may have adverse effects on bone marrow function, use cautiously in patients with depressed bone marrow reserve. Amphotericin B commonly causes renal impairment. Fluconazole requires dosage adjustment in the presence of renal impairment. Adverse reactions to fluconazole may be more severe in HIV-positive patients. The IV formulation of voriconazole should be avoided in patients with renal impairment.

Interactions

Differ greatly among various agents. See individual drugs.

Nursing Implications

Assessment

• Assess patient for signs of infection and assess involved areas of skin and mucous membranes before and throughout therapy. Increased skin irritation may indicate need to discontinue medication.

Potential Nursing Diagnoses

• Risk for infection (Indications)
• Impaired skin integrity (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Available in various dosage forms. Refer to specific drugs for directions for administration.
• Consult physician or other health care professional for cleansing technique before applying medication. Wear gloves during application. Do not use occlusive dressings unless specified by physician or other health care professional.

Patient/Family Teaching

• Instruct patient on proper use of medication form.
• Instruct patient to continue medication as directed for full course of therapy, even if feeling better.
• Advise patient to report increased skin irritation or lack of therapeutic response to health care professional.

Evaluation/Desired Outcomes

• Resolution of signs and symptoms of infection. Length of time for complete resolution depends on organism and site of infection. Deep-seated fungal infections may require prolonged therapy (weeks–months). Recurrent fungal infections may be a sign of serious systemic illness.