Azoles

The azoles other than voriconazole and posaconazole are commonly used orally for the treatment of dermatophytoses. Pulse or intermittent dosing with itraconazole is as effective in onychomycoses as continuous dosing because the drug persists in the nails for several months. Typically, treatment for 1 wk is followed by 3 wk without drug. Advantages of pulse dosing include a lower incidence of adverse effects and major cost savings. Topical forms of various azoles are also available for use in dermatophytoses  Imidazoles are azole derivatives, they have a wide range of activity against Epidermophyton, Microsporum, Trichophyton, Candida albicans, and Malassezia furfur, depending on the agent. Topical use is associated with contact dermatitis, vulvar irritation, and edema Miconazole is a potent inhibitor of warfarin metabolism and has produced bleeding in warfarin-treated patients even when applied locally to the vaginal area. No significant difference in clinical outcomes is associated with any azole or nystatin in the treatment of vulvar candidiasis