Ointments for thrush

Since thrush (candidiasis) is a consequence of a specific fungal infection, any means against the symptoms of the disease (rash, redness, itching, maceration, discharge) are not suitable. An effective ointment for thrush is needed, that is, etiotropic treatment with external agents that act directly on the causative agent of the disease - the yeast-like saprophytic fungus Candida albicans.

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Indications thrush ointments

The main indications for the use of ointments for thrush: candidiasis of various localizations with lesions of the skin and mucous membranes by C. albicans (much less often the cause of the pathology are fungi C. tropicalis, C. glabrata, C. parapsilosis and C. krusei), including thrush or urogenital candidiasis - candidal vulvovaginitis, balanitis, balanoposthitis. Such external agents are also used for candidiasis lesions of the perianal area, armpits, nail plates and skin of the periungual fold (onychomycosis).

Some ointments used for thrush are also used for other types of fungal diseases, in particular those caused by yeast-like fungi Rhodoturola mucilaginosa, Rhodotorula glutinis, Malassezia furfur, Torulopsis glabrata, as well as Aspergillus and dermatophytes Microsporum, Trichophyton, Epidermophyton.

It should be noted that the ointment for thrush for women does not differ by the "gender" of the patient, and the ointment for thrush in men is absolutely no different. So the mandatory simultaneous treatment of urogenital candidiasis in both partners (in her case - candidal vulvovaginitis, in his case - balanitis) is carried out with the same drugs.

Read also:

• Creams for thrush
• Candles for thrush
• Tablets for thrush
• Review of effective folk remedies for thrush

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Release form

The list of the most effective antifungal agents prescribed by gynecologists and dermatologists includes the following names of ointments for thrush:

• Clotrimazole ointment, as well as other trade names of ointments with the same active substance: Candid ointment, Canesten, Canison, Agisten, Lotrimin, Yenamazole, Antifungol, Oronazole;
• nystatin ointment;
• Pimafucin ointment;
• Pimafukort ointment;
• Levorin ointment;
• Lomexin cream;
• Miconazole ointment (Daktar, Daktarin, Mikozon, Surolan, etc.);
• Zalain (cream);
• Triderm ointment.

But ointments that are not used in the treatment of thrush include:

• Akriderm ointment (contains the corticosteroid betamethasone and the antibiotic gentamicin, which is not effective against C. albicans);
• Acyclovir ointment (intended for the treatment of skin lesions caused by the herpes virus);
• Methyluracil ointment (used for radiation skin lesions, poorly healing burns, wounds and ulcers);
• tetracycline ointment (used for infectious lesions of the skin and subcutaneous tissue accompanied by suppuration);
• syntomycin ointment and its synonym - Levomekol ointment (contains the antibiotic chloramphenicol and is used in the treatment of pustular lesions and purulent-necrotic inflammations of the skin, wounds, cracks, burns and ulcers);
• streptocide ointment (used for abscesses of the skin and subcutaneous tissue, furuncles, phlegmon, erysipelas, burns and wounds);
• calendula ointment (helps with minor skin lesions);
• zinc ointment (antiseptic, anti-inflammatory and anti-exudative agent, but does not work on the Candida albicans fungus);
• oxolinic ointment (used for viral inflammation of the nasal mucosa, as well as for vesicular and psoriasis).

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Pharmacodynamics

Clotrimazole ointment (Candida ointment, Canesten and other synonyms) contains the imidazole derivative clotrimazole, which inactivates mitochondrial peroxidase enzymes in Candida cells, reduces the biosynthesis of sterols necessary for the formation of glycoprotein adhesin of the fungal cell membrane, which reproduces not by spores, but by budding. As a result of the lack of sterols, the plasma membranes of fungal cells lose their impermeability, and with it the ability to reproduce and exist.

The drug Lomexin in the form of a vaginal cream acts in the same way, but due to another imidazole derivative - fenticonazole, in Zalain ointment the active antifungal substance is the antimycotic sertaconazole, and the pharmacodynamics of the ointment for thrush Miconazole is based on the action of miconazole nitrate.

Thanks to nystatin (antibiotic polyene mycosaminyl nystatinolide), Nystatin ointment also affects the cell membrane of fungi, and, by integrating into it at the molecular level, irreversibly increases the intracellular osmotic concentration of electrolytes, reduces the pH level and disrupts the process of oxygen consumption by fungal cells. All this together provokes coagulation of cytoplasmic proteins, leading to lysis of C. albicans cells.

The antifungal effect similar to nystatin is provided by the ointment for thrush Levorin (with the heptaene aromatic antibiotic levorin).

Pimafucin ointment contains polyene natamycin, the pharmacodynamics of which are similar to clotrimazole. Pimafukort ointment, in addition to natamycin, contains neomycin, an antibiotic active against many bacteria, and hydrocortisone, which relieves inflammation and itching of the skin during thrush.

Triderm ointment contains the corticosteroid betamethasone, the antibiotic gentamicin and clotrimazole. The action of clotrimazole was described above; gentamicin prevents the addition of a bacterial infection, and the corticosteroid helps relieve inflammation and itching.

And although all of the listed remedies reduce the appearance of symptoms of candidiasis, due to the corticosteroids in Pimafucort and Triderm, both ointments for itching during thrush are the most effective.

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Pharmacokinetics

When applied to the mucous membranes in vaginal candidiasis (thrush), the absorption of clotrimazole, which is contained in Clotrimazole ointment, Candid ointment and Triderm ointment, does not exceed 5-10%, and its concentration in vaginal mucus (with intravaginal application) is much higher than in blood plasma, and persists for 2-3 days. Clotrimazole is transformed in the liver and excreted through the intestines.

Nystatin ointment is not absorbed through mucous membranes and penetrates poorly through intact skin, therefore systemic absorption of the drug has not been noted.

In the absence of damage to the skin and mucous membranes, Pimafukort ointment is also poorly absorbed; adsorption of hydrocortisone ranges from 1 to 5%. There is no data on the biotransformation of the ointment components in the instructions.

The description of the pharmacokinetics of the drug Lomexin indicates that fenticonazole is practically not absorbed and its content is not detected in the blood.

The instructions for the ointments Pimafucin, Levorin and Triderm do not contain information regarding the adsorption, systemic metabolism and elimination of these drugs from the body.

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Dosing and administration

Any ointment for thrush should be applied to the affected area in a thin layer twice a day. When applying the ointment, it is recommended to capture 5-10 mm of the surface of intact skin surrounding the damaged area.

Clotrimazole ointment (Candide ointment, etc.) is used for about a month; Nystatin ointment is used for a maximum of 10 days; Pimafucin ointment is used for 15-20 days. Women should insert Lomexin and Pimafucin ointments deep into the vagina 1-2 times a day (morning and evening), and men should apply them to the genital and anus area. Use the ointment until the symptoms of thrush have completely disappeared, and for about a week more - as an ointment for the prevention of thrush.

Pimafukort ointment can be used twice a day for 14-28 days, 4 times a day is allowed (in acute forms of candidiasis or dermatoses), adults can apply a bandage.

Miconazole ointment is recommended to be lightly rubbed into the affected area after application; the course of treatment with this product is on average 4 weeks.

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Use thrush ointments during pregnancy

The use of ointments for thrush Pimafukort, Miconazole, Levorin, Zalain and Triderm is not recommended for pregnant and lactating women; Clotrimazole ointment should not be used in the first three months of pregnancy.

It is permissible to use Pimafucin ointment in the treatment of thrush in pregnant women, and nystatin ointment and Lomexin can be prescribed during pregnancy only if the expected benefit to the mother outweighs the potential risk to the fetus.

Contraindications

Ointments for thrush have the following contraindications for use:

• Clotrimazole ointment (Candide ointment, etc.), Pimafucin, Lomexin, Zalain should not be used in case of hypersensitivity to the components of these drugs.
• Inexpensive ointments for thrush - Nystatin and Miconazole - are also not used in cases of individual intolerance, which manifests itself in dermatological allergic reactions.
• Pimafukort ointment and Triderm ointment (due to the content of hydrocortisone) are contraindicated in cases of increased reaction of the body to exogenous steroids and are not used in cases of skin forms of venereal diseases, a tendency to acne, ulcers and other open lesions of the skin and mucous membranes.
• Levorin ointment is contraindicated in the presence of any manifestations of allergy in the anamnesis.

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Side effects thrush ointments

Among the most typical side effects of topical agents, almost any ointment for thrush, first of all, can cause local irritation, hyperemia and swelling of the skin and mucous membrane. This is typical for such drugs as Clotrimazole ointment (Candid ointment), Pimafucin and Mikazol ointments, Levorin, Lomexin ointments. And the drug Zalain can provoke erythema and temporary contact dermatitis.

Intravaginal use of ointments containing imidazole derivatives may be accompanied by burning, itching, increased discharge, and swelling of soft tissues and mucous membranes. Headaches and stomach pains, discomfort during urination and their increased frequency are not excluded.

Long-term use of Pimafukort or Triderm ointment may lead to the formation of strip-like skin atrophy (striae) at the site of application, lightening of the skin pigment at the site of application of the drug, as well as the expansion of skin capillaries in the form of a vascular network.

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Overdose

According to manufacturers, overdosing on anti-thrush ointments has not been observed.

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Interactions with other drugs

When using Clotrimazole ointment (Candide ointment), you cannot use other external antifungal agents with polyene antibiotics (nystatin ointment, Pimafucin), since the therapeutic effect of the drugs is reduced.

Data on drug interactions of other ointments for thrush indicated in the review are not provided in the instructions.

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Storage conditions

Ointments Clotrimazole (Candide), Pimafucin, Pimafucort, Zalain, Lomexin,

Miconazole ointment, Triderm ointment should be stored away from light, at a temperature not exceeding +25°C.

Nystatin ointment and Levorin ointment – at a temperature not exceeding +5-6°C.

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Shelf life

Clotrimazole ointment (Candide, etc.), nystatin ointment, Pimafucin, Lomexin, Zalain, Levorin and Triderm ointments are suitable for use for 3 years; Pimafukort ointment - 4 years.

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