FLUCONAZOLE: A USEFUL ANTI-FUNGAL FOR FISH?
I’ve written quite a bit about antibiotics in the past, but not every medication you use to treat infection are meant to kill bacteria. Viruses and fungi can also cause infection, and you will have to stockpile drugs that are effective against these organisms. This article will discuss fungal disease.
Fungal infections are also known as “mycoses”, and most often start in skin, lungs, oral cavity, or vagina. Skin infection with fungi was reported as the fourth most common disease in the world in 2010, affecting almost a billion people.
In disaster settings, common fungal infections like ringworm, athlete’s foot, and jock itch will be rampant in wet climates or in situations where you might not be able to change socks or underwear routinely. The family medic must be ready to deal with these problems just as they must deal with bacterial wound infections or viral influenza.
Fungal infections also occur as a result of the use of antbiotics to kill bacteria. Many antibiotics are broad-spectrum, meaning that they kill or inhibit a wide variety of bacteria. This effect often kills good as well as bad bacteria, leaving the neighborhood empty and ripe for opportunists like fungi to take over.
Fungal skin infections most often involve the feet, hands, nails, and scalp. These sites may exhibit fungal conditions like athlete’s foot (also called “tinea pedis”) or ringworm (“tinea versicolor”). Clotrimazole (Lotrimin) is a good choice as an antifungal, as it comes in cream or powder, and doesn’t require a prescription. Medications like Miconazole (Monistat) would be useful for vaginal yeast infections.
Oral antifungals exist as well, such as Fluconazole (Diflucan). This drug is now available as a fish medicine in the form of Fish-Flucon. Fluconazole is a member of the triazole antifungal family. It is thought to work by interfering with enzymes needed to form the fungal cell membrane.
Fluconazole (available in 50, 100, 150, 200 mg tablets and oral suspensions) may be effective in the treatment of a wide range of fungal infections, including:
Candidiasis (vaginal, oral, and elsewhere)
Blastomycosis (a contaminant of moist soil and decaying plant matter)
coccidiodomycosis (valley fever in parts of the western U.S.)
cryptococcosis (skin, lung, and brain infection found in bird droppings, not to be confused with cryptosporidium discussed in a recent article)
histoplasmosis (lung infection found in bat and bird droppings, often called “Caver’s Disease)
dermatophytosis (ringworm, athlete’s foot, jock itch)
onychomycosis (fungal infections of the fingernails or toenails)
pityriasis versicolor (infection that causes light colored patches on skin)
100 to 200 mg of Fluconazole orally once a day for 7 to 14 days is a standard course of treatment for most conditions, although a 150 mg dose taken once may be successful in eliminating vaginal yeast infections. Nail fungus can be treated with 150-300 mg taken once a week.
For severe conditions like fungal pneumonia, coccidioidomycosis, cryptococcus, and other serious infections, 400 mg once a day may be required for weeks to months, dependent on the immune status of the patient. For fungal bladder infections, 100-200 mg orally once a day may be effective.
Pediatric dosage ranges from 6-12 mg/kg per day. Duration depends on the disease.
Fluconazole may be taken with or without food. It can be taken even if allergic to penicillin, but not if pregnant. As long as short-term therapy is used, breastfeeding is acceptable.
Common side effects include vomiting, diarrhea, stomach upset, rash, headache, dizziness, and changes in taste sensations.
Fluconazole may fill a hole in long-term survival settings where modern medical care does not exist. For your fish, that is.
Joe Alton MD
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