Home' Australian Journal of Pharmacy : Jan-Feb 2017 Contents “In some cases it can be better to
choose a product that’s applied daily,
instead of once a week, because you get
into the habit of applying it ever y day.
“ W ith other products, once a week
can become once ever y two weeks,
or then it’ll be a month before you
remember to apply it again.”
Candida albicans is the most prevalent
fungal pathogen in humans, and
globally, more than 100 million women
will suffer recurrent thrush infections
Thrush is also the archetypal
example used to question how
discreetly pharmacy manages
awkward questions and product
requests—and while many customers
are embarrassed about seeking help,
it’s important that they do so.
“Thrush is always an interesting
one, because there’s some customers
that will shout [the request] across
the room and others are really
embarrassed,” says Hagidimitriou.
“A lot of women think they have
thrush but they could really have
dermatitis, which wherever it appears is
often mistaken for a fungal infection.
The symptoms can be similar.”
Latex allergy in women who use
condoms may be a likely suspect,
“ We had a customer not long ago
who was breastfeeding, and said
that she had thrush but made the
connection that she only seems to get
it when she’s breastfeeding and has to
“That’s a good example of someone
who needs to go to the doctor if it
keeps happening, because it may not
be thrush at all.
“In older women, what they think
is thrush may actually be vaginal
dryness due to hormonal changes,
so it’s really important that it’s
the pharmacist that’s involved in
the conversation, particularly if a
customer is repeatedly asking for
“And recurrent thrush is of concern
for anyone—why are they getting
it? It shouldn’t really be recurring.
It’s important to refer onto a doctor,
as in some cases the infection may
not be caused by the usual candida
but another type of fungal infection
entirely; in a case like that you’d need
to have it diagnosed via a swab.”
Recurrent thrush can also be a
symptom of undiagnosed diabetes;
and likewise, people with a diabetes
diagnosis may continue to be more
prone to thrush, particularly if their
condition is not well controlled.
“Diabetes is so complicated and
it can be so overwhelming when
someone’s been first diagnosed
that they don’t receive the support
they need,” Hagidimitriou says.
“Some have never even heard of a
She says there is a strong role for
pharmacists in talking to people
with diabetes about self care, and
helping prevent thrush, whether oral
High sugar levels provide a better
env ironment for candida albicans
to grow, and damaged skin also
promotes its growth.
“Then there’s nipple thrush, which
is quite common with new mums, and
often the baby will get oral thrush,”
Hagidimitriou says. “These are all
opportunities for counselling, as is
talking to women who are on oral
contraceptives, and talking to people
who are on some asthma medications
about maybe using a spacer and
washing out their mouth after using
Prevention of thrush infections
remains important, in part due to the
development of drug resist ance.
A 2016 study reviewed the literature
on natural products and sources of
new antifungal drugs to treat candida
albicans and found that the search for
new drugs is promising, with a long
list of natural substances showing
activity against the yeast infection.
“Investigations must be pursued
not only to found more new anti-
Candida compounds from plants
and organisms but also to [carry] out
details on molecules from already
known anti-Candida compounds and
to more elucidate mechanisms of
action,” the authors concluded.
In the meantime, Hagidimitriou
“These exist to take alongside
antibiotics, which we recommend
for women if they’re prone to thrush
– they’re a yeast that competes
against the candida that can become
HEALTH FOCUS ANTIFUNGALS
Warm climate; and moist climate.
Preferred sites of fungal invasion:
Moist folds of skin, eg groin, toe webs, armpits; and areas of
potential perspiration, eg feet, toe webs, head.
Obesity; diabetes; immunocompromisation eg AIDS,
radiotherapy, blood disorders, post-surgical, genetic defects; and
Oral antibiotics; and oral contraceptives.
Wearing occlusive clothing or footwear.
By Karalyn Huxhagen
In April 2016 the US Food and Drug Administration
announced that prescribers should exercise caution over
the use of oral fluconazole (Diflucan) in pregnancy.
The FDA said that Danish data indicates a possible
increased risk of miscarriage when fluconazole is used to
treat yeast infections. The Danish study examined a cohort
of 1,405,663 pregnancies and compared oral fluconazole-
exposed pregnancies with up to four unexposed
pregnancies matched on propensity score, maternal age,
calendar year, and gestational age.
The researchers found a significantly increased risk
(48%) of spontaneous abortion associated with fluconazole
However, no significant association was found between
fluconazole exposure and stillbirth.
In the study, most of the oral fluconazole use appeared to
be 1 or 2 doses of 150mg.
A spokesperson for the Department of Health said the TGA “is
aware of the FDA’s announcement and is reviewing information
to determine whether there are concerns in Australia”.
FACTORS PROMOTING FUNGAL INFECTION
DIFLUCAN IN PREGNANCY WARNING
In a clinical trial, 28% of subjects had a dermatophyte-negative culture after just one month of treatment1
Mycological cure rate of 62% after just six months of treatment1
60% of subjects showed an overall improvement in total visual assessment after six months treatment1
Treats the damage
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Reference: 1. Nasir, A., Swick, L., et al., “Clinical Evaluation of Safety and Efficacy of a New Topical Treatment for Onychomycosis”. J. of Drugs in Dermatology. 2011;10;10;1186-1191.
RestoraNailTM Nail Solution (Poly-ureaurethane 16% in organic solvents, 15mL) is a nail treatment solution for use with nail dystrophy and fungal infections. AFT Pharmaceuticals Pty Ltd, Sydney. ABN 29105636413
1800 2387 4276
Hartley Atkinson M.Pharm, PhD
Founder & CEO, AFT Pharmaceuticals
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