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Itraconazole - triazole antifungal agent with a broad spectrum of activity, the structure of which forms a five-membered triazole ring with three nitrogen atoms.
The mechanism of action of the drug has been well studied and is based on inhibition of the biosynthesis of ergosterol, an essential component of membranes of fungal cells. Itraconazole also has anti-inflammatory activity through inhibition of 5-lipooksidazy metabolites, which allows to use the drug for the treatment of inflammatory skin diseases. Itraconazole capsules are well absorbed when taken with food, especially fat, is highly lipophilic and 99.8% bound to plasma proteins, primarily albumin. The drug is a compound keratinofilnym and tend to accumulate in the skin, hair and nails, which may persist in the treatment of concentration for a long time after treatment (in the stratum corneum - 2-4 weeks, your nails - 6-9 months). Transport in the skin occurs primarily through sebum, small amounts are excreted in sweat, and are included in the basal layer of the epidermis by passive diffusion from the blood. The drug reaches the nail via the nail matrix and nail bed [1]. The unique ability of inhibiting metabolites 5-lipooksidazy can use the drug in the treatment of certain inflammatory diseases.  At present, along with the original, there are many generic drugs that optimize the ratio of "money" in the treatment of patients. One of the most popular generic itraconazole is "Mikotroks", manufactured by the pharmaceutical company ╚Pharmacare Int. Co ╩. Compliance with the original drug proved as a result of GSP studies. Today in Belarus received information on the clinical use of the drug for the treatment of kerato-and onychomycosis, vulvovaginal candidiasis and chronic fungal rhinosinusitis [4, 6, 7, 8, 9].
The use of "Mikotroksa" in the treatment of inflammatory diseases, associated with yeast fungi of the genus Malassezia. ═ According to the classification AJ Sergeyev and Y. Sergeev (2004), Malassezia-associated dermatoses are classified as follows: ╥ Malassezia-infection - pityriasis versicolor, Malassezia-folliculitis, neonatal pustulosis, otitis media; ╥ Malassezia-related diseases - seborrheic dermatitis (SD), dandruff, Guzhero syndrome, Cortot; ╥ Chronic dermatoses, in which Malassezia may be a precipitating factor - atopic dermatitis, psoriasis [10]. Minimum inhibitory concentration of itraconazole when subjected to strains of M. furfur - 0,1 mg / liter. Given the numerous publications on the use of the drug in the treatment of these diseases, "Mikotroks" can be recommended for the treatment of pityriasis lichen, Malassezia - folliculitis, seborrheic dermatitis, atopic dermatitis, with lesions of the face and neck, seborrheic psoriasis as follows (Table 1). Table 1. Schematics of the drug "Mikotroks" Disease | The scheme of itraconazole ("Mikotroks") | Chromophytosis | ╥ 200 mg daily for 5 days ∙ 100 mg daily for 10 days ╥ 50 mg daily for 4 weeks ∙ 100 mg daily for 4 weeks ╥ 100 mg 2 times daily for 5 days ∙ 100 mg daily for 5 days | Seborrheic dermatitis | ╥ 200 mg / day for 7 days, after which maintenance regimen of 200 mg / day in the first two days of each month. ╥ 200 mg once a day for one week, and then - 400 mg monthly for 2-6 months | Atopic dermatitis with lesions of the face and neck | ╥ 100 mg once a day for one week, then break for three weeks, then - the repetition rate; ╥ 200 mg weekly for four weeks; ╥ 100 mg per day for a week, then - 200 mg per week for four weeks. | Note: for the treatment of these diseases, as well as psoriasis, seborrheic with lesions of the skin may apply a unified scheme, developed by the author in collaboration with prof. VP Adaskevichem. It is most appropriate for severe disease. "Mikotroks" administered 100 mg twice daily after meals for 14 days. Before and after treatment to carry out a study of indicators of enzymatic activity of the liver (transaminases, bilirubin). Patients who have noted a slight improvement, it is necessary to recommend maintenance therapy on the proposed method, we have a dose of 200 mg for two days each month for 3 - 6 months [1, 3]. |
═ The use of "Mikotroksa" in the treatment of onychomycosis. ═ For the treatment of onychomycosis "Mikotroks" may be used in two ways. The first way - the appointment of "Mikotroks" on a continuous method: 200 mg daily for 30 days. Possible to use it and the method of pulse - therapy. One "pulse" is to receive 200 mg of "Mikotroks" 2 times a day for 7 days, then a break - 14 - 21 days. For the treatment of onychomycosis caused by yeast-like fungi of the genus Candida, there are enough 2 "pulse" taking "Mikotroks", and for onychomycosis caused by dermatophytes, to 3.4 pulse [5]. "Mikotroks" is quite effective in the treatment of onychomycosis and in patients with diabetes, their high level of safety spectrum [4]. The use of "Mikotroksa" in the treatment of fungal infections of the skin. ═ Itraconazole is highly effective against dermatophytes. Thus, the minimum inhibitory concentration for the most frequent pathogen T. rubrum reaches 0,001 mg / liter. "Mikotroks" is shown in disseminated skin lesions, failure of local therapy, contraindications to the use of local funds. On this basis, the following scheme for the treatment of fungal infections of the skin smoother: ╥ 200 mg daily for 7 days, then (if necessary) to 100 mg daily for 1-2 weeks; ╥ Pulse - therapy (similar to use in onychomycosis). Typically, for the treatment of lesions of the skin smooth with only two "pulses". The use of "Mikotroksa" in the treatment of fungal infections of the scalp. Data on the use of itraconazole in the treatment of dermatophyte infections of the scalp are scarce. However, there is a view that the drug is equally effective with respect to mikrosporumam and Trichophyton. In some countries, itraconazole is the drug of choice for treatment of fungal infections of the scalp. Standard dose of itraconazole, used to treat fungal infections of the scalp, is 5 mg / kg / day, duration of treatment varies from 4 to 12 weeks [2, 11]. In Belarus itraconazole approved for use in 12 years, and the bulk of patients with mycosis of the scalp - the children. However, as we know, microsporia caused by M. sanis is often resistant to treatment with other medicines. In such cases, the decision on consultation "Mikotroks" may be designated as an alternative therapy [2]. The use of "Mikotroksa" in the treatment of vulvovaginal candidiasis. ═ Clinical effectiveness "Mikotroks" in the treatment of vulvovaginal candidiasis studied BelMAPO IG staff Shimanskaya and EA Levonchuk. They suggested the following scheme of the drug: ╥ Acute vulvovaginal candidiasis - 200 mg 2 times a day 1 day; ╥ Chronic vulvovaginal candidiasis - 200 mg 1 time a day for 3 days; ╥ To prevent vulvovaginal candidiasis - 200 mg 1 time periods, for 4 - 6 months [6, 7]. It should be noted that "Mikotroks" is sold in a package of four and 14 capsules, which optimizes the drug in different forms of the disease and the patient saves money. The use of "Mikotroksa" in the treatment of deep mycosis. In Belarus deep mycoses are rare, however, is currently growing population infection with HIV, and therefore the role of opportunistic infections. Itraconazole has long established itself as the drug of choice in the treatment of fungal opportunistic and subcutaneous mycoses. Recommended regimens "Mikotroks" at chromomycosis, blastomycosis, eumikoticheskoy mitsetome (after removal of the source), cryptococcosis, histoplasmosis - drug is given at a dose of 200 mg a day for the treatment of sporotrichosis enough 100 mg per day. The duration of treatment of deep mycosis - 3-4 months. When a drug should be considered a possible hepatotoxic effects. The drug is contraindicated in patients with acute liver failure and acute exacerbation of chronic liver disease. With prolonged use, "Mikotroks" (more than a month) to evaluate the activity of alanine and aspartate aminotransferase, lactate dehydrogenase. Thus, given the accumulated data on the efficacy of itraconazole and the results of clinical efficacy "Mikotroks" field of application is wide and includes the whole spectrum of fungal diseases, as well as certain inflammatory skin diseases. References: 1. Adaskevich, VP Features of treatment of inflammatory dermatoses, associated with yeast fungi of the genus Malassezia / VP Adaskevich, V. Kozlovskaya / / Health. - 2005. - № 5. - S. 22-24. 2. Adaskevich, VP The efficacy and safety of itraconazole in the treatment of children with mikrosporiya / VP Adaskevich, IV Tikhon / / Medical News. - 2007. - № 14. - S. 51 - 52. 3. Adaskevich, VP, Kozlovsky, VV Malassezia - associated dermatoses / VP Adaskevich, V. Kozlovsky. - VSMU, 2007. - 160. 4. Vetokhin, EL Using Mikotroksa (itraconazole) in the treatment of onychomycosis in diabetic patients / EL Vetokhin, NV Circle / / Medical Panorama. - 2006. - № 7. - S. 62 - 63. 5. Korsun, IM Athlete's foot and onychomycosis: a combined treatment / IM Korsun / / Consilium Medicum. - 2003. - T. 5. - № 3. 6. Levonchuk, E. Vulvovaginal candidiasis / / EA Levonchuk. - Medical News. - 2007. - № 1. 7. Levonchuk, E. Vulvovaginal candidiasis: current approaches to therapy of various forms of his / E. Levonchuk, IG Shimanskaya / / recipe. - 2007. - № 3. 8. Levonchuk, E. Pityriasis versicolor: clinical picture, diagnosis, modern therapy. - Medical News. - 2007. - № 13. 9. Redko, JD Systemic antimycotic therapy of chronic fungal rhinosinusitis / DD Redko, ID Shlyaga, NI Shevchenko / / Medical Panorama. - 2008. - № 9. 10. Sergeev, AJ Fungal infections. Guide for physicians / AU Sergeev, YV Sergeyev. - Moscow: OOO "Bean-Press", 2004. - 440. 11. Ginter-Hanselmayer, G. Itraconazole in the treatment of tinea capitis caused by Microsporum canis: experience in a large cohort / G. Ginter-Hanselmayer, J. Smolle, A. Gupta / / Pediatr. Dermatol. - 2005. - Vol. 22. - P. 372. Kozlovsky, VV "Medical Panorama" 2009, № 6
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