[Antimycotic therapy in clinical practice]

Mycoses commonly encountered in outpatients in Europe are usually limited to body surfaces and are no threat to the patient. Topical or systemic therapy with modern antimycotics is usually effective. Improved pharmacokinetic properties of newer azoles have shortened and simplified treatment of the mucosal forms of candidiasis for which a single dose of fluconazole (150 or 200 mg) or a short course with two doses of itraconazole (2 x 100 mg) are recommended. For patients with an uncorrectable predisposition to thrush, guidelines are provided for prophylaxis or self-initiated therapy. Whenever possible dermatophytoses should be treated topically to avoid long-term exposure to the new keratinotropic azoles and allylamines, for which insufficient long-term toxicological data are at present available. Ketoconazole should be avoided for these indications because of its potentially serious hepatotoxicity. For many indications requiring prolonged treatment griseofulvin remains the favoured systemic drug due to its extensive safety record.