NUR 600 Clotrimazole Discussion

Diaper Candida

Therapeutic Actions of Clotrimazole (Lotrimin)

Clotrimazole is a drug from the imidazole group. According to Khatter and Khan (2022), its action is against an abroad spectrum of microorganisms, including fungus, certain gram-positive bacteria, trichomonas bacteria, Epidermophyton floccosum, and trichophyton. It impairs the fungal cell cytoplasmic membrane’s permeability, enabling it to function and transport substances properly. Hence, the cells have content leakage and undergo lysis. The main action of this drug is inhibition of ergosterol synthesis by reduction of the demethylation of 14 alpha lanosterol. As a result, fungal cells cannot build functional membranes for the new cells. Due to the lack of ergosterol, the fungal cells do not have enough growth promotion stimuli, inhibiting their growth. According to Khatter and Khan (2022), the action against other non-fungal bacteria is provided by Ca2+ ATPase inhibition, calcium-dependent channel blockage, and reduced intracellular calcium content. Considering that Clotrimazole has various routes of administration, it can be used against many fungal infections. For instance, it is effective against oropharyngeal and vaginal candidiasis and topical fungal infections.

Antifungal Drug Uses and Side Effects

Antifungal drugs can be used against a variety of mycoses. For example, they manage local infections (superficial, cutaneous, and subcutaneous) and systemic illnesses (deep and bloodborne). Such medications are effective against exogenous and endogenous conditions when normal fungal flora is activated due to immunosuppression processes. The most aggressive microorganisms among fungus in these cases are Candida albicans, Aspergillus fumigatus, and Cryptococcus neoformans. According to McKeny et al. (2021), antifungal agents can be used against these common medically relevant mycoses, such as aspergillosis, blastomycosis, candidiasis, chromomycosis, cryptococcosis, dermatophytosis, histoplasmosis, sporotrichosis, and coccidiomycosis. In particular, Clotrimazole is effective in the case of patient’s suffering from tinea corporis, tinea pedis, tines versicolor, cutaneous fungal infection, vaginal yeast infections, and for the treatment of oropharyngeal fungal infection. The route of administration varies and depends on the source and location of infection. For example, acceptable preparations include tablets capsules along with the solutions for oral and intravenous use. Moreover, topical agents are available in the form of cream, ointment, gel, shampoo, or powder. Hence, antifungal drugs can be used in the various cases.

Antifungal medications might have adverse effects. Typically, they are not severe, and these drugs are well-tolerated. However, severe reactions are possible. For instance, hepatotoxic effects, namely elevated liver enzymes, hepatitis, and fulminant liver failure. Less severe reactions include nausea, vomiting, diarrhea, or abdominal pain that are more frequent. According to McKeny et al (2021), Clotrimazole might have local reactions when used topically, for instance, burning, itching, urticarial, irritation, and pruritis. Consequently, antifungal drugs have different side effects from light to severe.   

Teaching Plan

The teaching plan predisposes parents’ education on antifungal medication use and hygiene of the diaper area. Non-pharmacologic measures for Sam include good hygiene of the diapers. In particular, Sam’s mother should change diapers more frequently than usual to avoid skin exposure to irritants (urine and feces). Sam should be bathed with soap-free cleaners and clean water (Burdall et al., 2018). The use of wet wipes is not recommended, especially for Sam, in order to avoid additional irritation of the skin and pH balance shift. After the course of Clotrimazole, Sam’s mother should use emollients topically for skin barrier, preventing over-hydration. Such substances include zinc oxide, cod liver oil, or lanolin (Benitez Ojeda & Mendez, 2022). According to McKeny et al. (2021), contrary to other antifungals from the azole group, Clotrimazole does not require laboratory monitoring in this case, such as checking the levels of hepatic enzymes. For 14 days, the cream needs to be administered twice daily. In this way, Clotrimazole and hygiene measures are included in the teaching plan.

Post 2: KO

Introduction

Candida albicans is a yeast that naturally lives in our bodies. Symptomatic forms of this can be related to infection, as is the situation of the provided case study, which includes Candida diaper dermatitis.  This is typically caused by skin breakdown due to friction from a diaper that is in a prolonged moist environment (Yeast Diaper Rash (Candida Diaper Dermatitis): Symptoms, Causes, Treatments, 2022).

Mechanism of Action

Clotrimazole (Lotrimin) is a prescription antifungal medication used to treat fungal infections of the skin. It can be used to treat ringworm infections, jock itch, athlete’s foot, and yeast infections of the skin. The mechanism of action relies on the disruption of the membrane of the cell of this microorganism, which eventually leads to its death. Considering these effects, the medication is classified as a synthetic imidazole. Clotrimazole is available in the form of cream, lotion, and spray. The medication is also available as a tablet that can be taken by mouth. The recommended dosage varies depending on the condition being treated and the age of the individual. Clotrimazole is considered safe in most individuals. However, there are some interactions that can cause adverse effects which will be discussed in the upcoming paragraph. Because clotrimazole works by interfering with the growth of fungi, it does not work for viral or bacterial infections (Bolla et al., 2019).

Potential Side Effects 

Antifungal drugs are primarily used to treat fungal infections of the skin, nails, and scalp. They are also used to prevent fungal infections in patients who are at risk for developing them.

There are several different types of antifungals, each named after the type of fungus they target. For example, amphotericin B is used to treat systemic fungal infections (those that affect multiple parts of the body), whereas fluconazole treats vaginal candidiasis (yeast infections).

The most common side effects can include nausea, headache, vomiting associated with diarrhea, and abdominal pain. Less common side effects are represented by itching associated with new difficulty breathing and dizziness. There also exists a risk for allergic reaction as in the case of any medication. In addition, antifungal drugs should not be taken by pregnant women without consulting with their doctors because they may cause harm to the fetus. Even though studies tend to be reluctant in providing a clear conclusion regarding the teratogenic effect, it would be better to be avoided during the mentioned period (Kumar et al., 2021)

Teaching Plan

The first part would consist of educating family members about the causative factors that contribute to this infection.  In the case of Candida diaper dermatitis, oral antifungal therapy is not recommended due to the risk associated with the colonization of Candida species that are resistant to fluconazole.  As a result, considering the presented manifestations, a topical application of clotrimazole would be the most appropriate approach. Clotrimazole is classified as a medication that is suitable both for adults and children. Even so, the parents should be educated on how they should apply it. It is recommended to clean the affected area and then dry it to eliminate any moisture. After that, the cream should be placed as a thin layer and followed by gentle rubbing. In addition, the parents should decrease the saturation of the affected skin by frequently changing the diaper and even removing the diaper for a while in between changes to increase airflow to the area (Hussein Karsani et al., 2017)

Conclusion

In conclusion, diaper yeast or Candida diaper dermatitis is a common issue seen in babies that can be treated with antifungal creams. It is important to keep the skin clean and dry and to treat all underlying infections. A simple diagnosis and treatment can significantly reduce the symptoms and decrease the length of infection.