1% cream - use lotion if 1-2 daily 1 week or in Treat with 1% azole cream treating paronychia case of paronychia until swelling Widespread Infection/Topical Treatment Ineffective/Immunocompromised If oral therapy indicated goes Patient (see left) 2 then Use oral fluconazole for 2 and then review response to treatment as follows: Fluconazole 50mg od review (see Infection completely resolved - stop treatment. left) Infection improved but not completely resolved, continue treatment for a further 2 Poor response or no improvement seek specialist advice. Indication Comment Drug Dose Duration Pityriasis Scratching the surface of the lesion should demonstrate mild scaling First Choice versicolor If initial therapy fails, verify that the treatment regimen has been followed Ketoconazole 2% shampoo once daily 5 days adequately. Consider a second topical therapy before considering systemic treatment. Second choice Topical or oral corticosteroids should not be used as they may exacerbate the Selenium sulphide 2.5% once daily 7 days condition and cause skin atrophy. shampoo (unlicensed indication) If pityriasis versicolor is extensive or if topical treatment is ineffective: Confirm the diagnosis by taking skin samples for microscopy. Small areas Consider referral to dermatologist or specialist, particularly if 12 years of age Clotrimazole 1% cream 2-3 times daily 2-3wks Consider an oral antifungal treatment If oral therapy indicated (see left) Choice Itraconazole od 7 days Second Choice Fluconazole 50mg od 2-4wks
Treat with 1% azole cream Widespread Infection/Topical Treatment Ineffective/Immunocompromised Patient Use oral fluconazole for 2 and then review response to treatment as follows: Infection completely resolved - stop treatment. Infection improved but not completely resolved, continue treatment for a further 2 Poor response or no improvement seek specialist advice. 1% cream - use lotion if treating paronychia If oral therapy indicated (see left) Fluconazole 1-2 daily 50mg od 1 week or in case of paronychia until swelling goes 2 then review (see left) Indication Comment Drug Dose Duration Pityriasis versicolor Scratching the surface of the lesion should demonstrate mild scaling If initial therapy fails, verify that the treatment regimen has been followed adequately. Consider a second topical therapy before considering systemic treatment. Topical or oral corticosteroids should not be used as they may exacerbate the condition and cause skin atrophy. If pityriasis versicolor is extensive or if topical treatment is ineffective: Confirm the diagnosis by taking skin samples for microscopy. Consider referral to dermatologist or specialist, particularly if 12 years of age Consider an oral antifungal treatment First Choice Ketoconazole 2% shampoo Second choice Selenium sulphide 2.5% shampoo (unlicensed indication) Small areas Clotrimazole 1% cream If oral therapy indicated (see left) Choice Itraconazole Second Choice Fluconazole once daily once daily 2-3 times daily od 50mg od 5 days 7 days 2-3wks 7 days 2-4wks
Doncaster-Bassetlaw-Antimicrobials-Guidelines-for-Primary-Care.docx