Genital Organ Disease Case No 4.Vaginitis

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Genital Organ Disease Case No 4.Vaginitis

𝐕𝐚𝐠𝐢𝐧𝐢𝐭𝐢𝐬 ***

Vaginitis 3 রকমের হতে পারে,,,

Bacterial Vaginosis

Trichomoniasis(Tricomonas vaginalis)

Candida vaginitis (Yeast infection)

কিভাবে ৩ টাকে আলাদা করতে পারি??চলুন যেনে নেই….

Risk Factor ***

-মাল্টিপল Sex partner*

-সেস্কুয়াল Activity

-ডায়াবেটিস

-IUD & প্রেগন্যান্সি

-PID

-Endrometriasis

-Douching

-টাইট ফিটিং Undergarments

-STD

-কিছু Antiobiotics

𝐁𝐚𝐜𝐭𝐞𝐫𝐢𝐚𝐥 𝐕𝐚𝐠𝐢𝐧𝐨𝐬𝐢𝐬

নরমাল ভ্যাজাইনাল ফ্লোরার imbalance,Vaginal Acidity লস এসব কারণে Bacterial Vaginitis হয়ে থাকে..

DX:-clue on Examination ____

• পাতলা ,অফ White, মিল্কি, Discharge হবে

• Fishy odor থাকবে***

• কোনো Inflammation থাকবে না..

• চুল্কানি থাকে না তেমন!

Treatment **

Tablet 1.Metronidazole (Metro 400mg) (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Indications of Tablet :-Metronidazole (Metro 400mg) (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Metro is indicated in the treatment of following diseases:

The prevention of post-operative infections due to anaerobic bacteria (particularly species of bacteroides and anaerobic streptococci).
The treatment of septicaemia, bacteraemia, peritonitis, brain abscess, pelvic abscess, pelvic cellulitis and post-operative wound infections caused by anaerobes.
In the treatment of urogenital trichomoniasis.
Bacterial vaginosis (also known as non-specific vaginitis).
All forms of amoebiasis (intestinal, extra-intestinal disease and that of symptomless cyst passers).
Giardiasis.
Acute ulcerative gingivitis.
Anaerobically infected leg ulcers and pressure sores.
Acute dental infections due to anaerobic organisms.
Antibiotic associated pseudomembranus colitis.

Pharmacology of Tablet :-Metronidazole (Metro 400mg) (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Metronidazole is a member of the imidazole class of antibacterial drug and is classified therapeutically as an antiprotozoal agent. The 5-nitro group of Metronidazole is reduced by anaerobes metabolically. Studies have demonstrated that the reduced form of this drug interacts with DNA and gives bactericidal action of Metronidazole.

Dosage & Administration of Tablet :-Metronidazole (Metro 400mg) (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Tablet and Suspension:

Trichomoniasis (Adults & Children over 10 yrs)-

200 mg tid or 400 mg bid for 7 days
800 mg in the morning and 1-2 gm at night for 2 days
2 gm as a single dose for 1 days

Trichomoniasis (Children)-

Children 7-10 yrs: 100 mg tid
Children 3-7 yrs: 100 mg bid
Children 1-3 yrs: 50 mg tid

Intestinal amoebiasis (Adults & Children over 10 yrs)-

800 mg tid for 5 days

Intestinal amoebiasis (Children)-

Children 7-10 yrs: 400 mg tid
Children 3-7 yrs: 200 mg qid
Children 1-3 yrs: 200 mg tid

Extra-intestinal & Asymptomatic amoebiasis (Adults & Children over 10 yrs)-

400-800 mg tid for 5-10 days

Extra-intestinal & Asymptomatic amoebiasis (Children)-

Children 7-10 yrs: 200-400 mg tid
Children 3-7 yrs: 100-200 mg qid
Children 1-3 yrs: 100-200 mg tid

Giardiasis (Adults & Children over 10 yrs)-

2 gm once daily for 3 days

Giardiasis (Children)-

Children 7-10 yrs: 1 gm once daily
Children 3-7 yrs: 600-800 mg once daily
Children 1-3 yrs: 500 mg once daily

Acute ulcerative gingivitis (Adults & Children over 10 yrs)-

200 mg tid for 3 days

Acute ulcerative gingivitis (Children)-

Children 7-10 yrs: 100 mg tid
Children 3-7 yrs: 100 mg bid
Children 1-3 yrs: 50 mg tid

Acute dental infections (Adults & Children over 10 yrs)-

200 mg tid for 3-7 days

Bacterial Vaginosis (Adults & Children over 10 yrs)-

400 mg bid for 7 days
2 gm as a single dose for 1 days

Leg ulcers and pressure sores (Adults & Children over 10 yrs)-

400 mg tid for 7 days

Anaerobic infections (Adults & Children over 10 yrs)-

800 mg initially and then 400 mg tid for 7 days

Anaerobic infections (Children)-

Children 1-10 yrs: 7.5 mg/kg tid

Surgical prophylaxis (Adults & Children over 10 yrs)-

400 mg tid started 24 hours before surgery for 1 days

Surgical prophylaxis (Children)-

Children 1-10 yrs: 7.5 mg/kg tid

Vaginal Gel:

The recommended dose is one applicator full of Metronidazole gel (approximately 5 grams containing approximately 37.5 mg of Metronidazole) intravaginally once or twice a day for 5 days. For once a day dosing, Metronidazole gel should be administered at bedtime.

Suppository:

Anaerobic Infections-

Adults: 1 g every 8 hours for 3 days, then 1 g every 12 hours.
Children: 5-10 years: 500 mg every 8 hours for 3 days, then every 12 hours, Over 10 years adult dose.

Surgical Prophylaxis-

Adults: 1 g 2 hours before surgery; up to 3 further doses of 1 g may be given every 8 hours for high risk procedures.
Children: 5-10 years: 500 mg 2 hours before surgery; up to 3 further doses of 500 mg may be given every 8 hours for high risk procedures.

IV Infusion:

Metronidazole intravenous infusion requires no dilution and should not be mixed with any other drugs prior to administration.

Adults and children over 12 years: Infuse 500 mg 8 hourly at a rate of 5 ml/minute and a maximum of 4 g should not be exceeded during a 24-hour period. Treatment for 7 days is sufficient for most patients, but treatment can be extended, especially for cases where reinfection is likely. For surgical prophylaxis, administration shortly before surgery should be followed by 8-hourly doses for the next 24 hours.
Children under 12 years: 7.5 mg/kg body weight/day every 8 hours at a rate of 5 ml/minute.

Side Effects of Tablet :-Metronidazole (Metro 400mg) (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Metallic taste, nausea, vomiting, diarrhoea, drowsiness, rashes may be observed during treatment.

Pregnancy & Lactation of Tablet :-Metronidazole (Metro 400mg) (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

US FDA Pregnancy Category of Metronidazole is B. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Metronidazole have been shown to be excreted in human milk. So, caution should be exercised when Metronidazole is administered to a nursing woman.

Therapeutic Class of Tablet :-Metronidazole (Metro 400mg) (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Amoebicides, Anti-diarrhoeal Antiprotozoal

TDS—7 দিন

𝐎𝐫

Vaginal Gel 2.Flamyd v-Gel 1.3% 5gm Tube (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Once daily(5gm )–5 দিন

𝐎𝐫

Vaginal Cream 3.Clindacin 2% 20gm tube (AS A Clindamycin AS A Macrolides).

Indications of Vaginal Cream:-Clindacin 2% 20gm tube (AS A Clindamycin AS A Macrolides).

Clindacin cream is indicated in the treatment of bacterial vaginosis. Clindacin cream can be used to treat non pregnant women and pregnant women during the second and third trimester.

Pharmacology of Vaginal Cream:-Clindacin 2% 20gm tube (AS A Clindamycin AS A Macrolides).

Clindamycin Phosphate is a water soluble ester that derived from the parent antibiotic Lincomycin. Clindamycin inhibits bacterial protein synthesis by binding preferentially to the 50s ribosomal subunit and affects the process of peptide chain initiation. In vitro Clindamycin is active against most strains of the following organisms that have been reported to be associated with bacterial vaginosis:

Bacteroides spp.
Gardnerella vaginalism
Mobiluncus spp.
Mycoplasma hominis
Peptostreptococcus spp.

Dosage & Administration of Vaginal Cream:-Clindacin 2% 20gm tube (AS A Clindamycin AS A Macrolides).

One applicator full (approximately 5 gram) intravaginally at bedtime for 7 consecutive days. In patients in whom a shorter treatment course is desirable, a 3-day regimen has been shown to be effective.

Contraindications of Vaginal Cream:-Clindacin 2% 20gm tube (AS A Clindamycin AS A Macrolides).

Clindamycin cream is not recommended in children under 12 years of age.

Side Effects of Vaginal Cream:-Clindacin 2% 20gm tube (AS A Clindamycin AS A Macrolides).

Clindacin may results the following side effects. Genital tract: vaginitis, vulvo-vaginal irritation Central nervous system: dizziness, headache, vertigo.Gastro-intestinal: heartburn, nausea, vomiting, diarrhea, constipation, abdominal pain. Dermatological: rash, exanthema. Hypersensitivity: urticaria.

Therapeutic Class of Vaginal Cream:-Clindacin 2% 20gm tube (AS A Clindamycin AS A Macrolides).

Macrolides

Once daily –7 দিন

Alternative Regiman**হিসেবে…..

Tablet 4. Tinizol DS 1gm (AS A Tinidazole AS A Amoebicides).

Indications of Tablet. Tinizol DS 1gm (AS A Tinidazole AS A Amoebicides).

Trichomoniasis: Tinizol DS is indicated for the treatment of trichomoniasis caused by Trichomonas vaginalis. The organism should be identified by appropriate diagnostic procedures. Because trichomoniasis is a sexually transmitted disease with potentially serious sequelae, partners of infected patients should be treated simultaneously in order to prevent re-infection.

Giardiasis: Tinizol DS is indicated for the treatment of giardiasis caused by Giardia duodenalis in both adults and pediatric patients older than three years of age. Sections or subsections omitted from the full prescribing information are not listed.

Amebiasis: Tinizol DS is indicated for the treatment of intestinal amebiasis and amebic liver abscess caused by Entamoeba histolytica in both adults and pediatric patients older than three years of age. It is not indicated in the treatment of asymptomatic cystpassage.

Bacterial Vaginosis: Tinizol DS is indicated for the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, or anaerobic vaginosis) in non-pregnant women.

Other pathogens commonly associated with vulvovaginitis such as Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans and Herpes simplex virus should be ruled out.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Tinizol DS and other antibacterialdrugs, Tinizol DS should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Pharmacology of Tablet. Tinizol DS 1gm (AS A Tinidazole AS A Amoebicides).

Tinidazole, a 5-nitroimidazole derivative with antimicrobial actions similar to metronidazole, is active against both protozoa (e.g. Trichomonas vaginalis, Entamoeba histolytica and Giardia lamblia) and obligate anaerobic bacteria. It damages DNA strands or inhibits DNA synthesis in microorganism.

Dosage of Tablet. Tinizol DS 1gm (AS A Tinidazole AS A Amoebicides).

Prevention of Postoperative Infections :

Adult: A single oral dose of 2g approximately 12 hours before surgery.
Children less than 12 years: Data are not available to allow dosage recommendations for children below the age of 12 years in the prophylaxis of anaerobic infections.

Trichomoniasis: a single 2 g oral dose taken with food. Treat sexual partners with the same dose and at the same time

Giardiasis:

Adults: a single 2 g dose taken with food.
Pediatric patients older than three years of age: a single dose of 50 mg/kg (up to 2 g) with food

Amebiasis, Intestinal:

Adults: 2 g per day for 3 days with food.
Pediatric patients older than three years of age: 50 mg/kg/day (up to 2 g per day) for 3 days with food

Amebic liver abscess:

Adults: 2 g per day for 3-5 days with food.
Pediatric patients older than three years of age: 50 mg/kg/day (up to 2 g per day) for 3-5 days with food

Bacterial vaginosis: Non-pregnant, adult women: 2 g once daily for 2 days taken with food, or 1 g once daily for 5 days taken with food.

Side Effects of Tablet. Tinizol DS 1gm (AS A Tinidazole AS A Amoebicides).

Reported side effects have generally been infrequent, mild and self-limiting. Side effects from the gastrointestinal tract include nausea, vomiting, anorexia, diarrhoea and metallic taste. Hypersensitivity reactions, occasionally severe, may occur in rare cases in the form of skin rash, pruritis, urticaria and angioneurotic oedema. As with related compounds, Tinizol DS may produce transient leukopenia. Other rarely reported side-effects are headache, tiredness, furry tongue and dark urine.

Pregnancy & Lactation of Tablet. Tinizol DS 1gm (AS A Tinidazole AS A Amoebicides).

Pregnancy Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Therapeutic Class of Tablet. Tinizol DS 1gm (AS A Tinidazole AS A Amoebicides).

Amoebicides

Once daily –২ দিন

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Tinidazole 1gm

OD–5 দিন

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Cap 5.Clindacin 300mg (AS A Clindamycin AS A Macrolides).

BD—7 দিন

Indications of Cap 5.Clindacin 300mg (AS A Clindamycin AS A Macrolides).

Clindacin has been shown to be effective in the treatment of the following infections when caused by susceptible anaerobic bacteria or susceptible strains of gram positive bacteria such as Streptococci, Staphylococci and Pneumococci; Upper respiratory infections, Lower respiratory infections, Skin and soft tissue infections, Bone and joint infections, Pelvic infections, Intra-abdominal infections, Septicemia and endocarditis, Dental infections. As an alternative therapy when used in combination with quinine or amodiaquine for the treatment of multi-drug resistant Plasmodium falciporum infection.

Description Cap 5.Clindacin 300mg (AS A Clindamycin AS A Macrolides).

Clindacin is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. Clindacin is a semisynthetic antibiotic derived from lincomycin.

Aerobic gram-positive cocci, including: Staphylococcus aureus, Staphylococcus epidermidis (penicillinase and non-penicillinase producing strains), Streptococci, Pneumococci.

Anaerobic gram-negative bacilli, including: Bacteroides species, Fusobacterium species.

Anaerobic gram-positive non-spore forming bacilli, including: Propionibacterium species, Eubacterium species, Actinomyces species.

Anaerobic and microaerophilic gram-positive cocci, including: Peptococcus species, Peptostreptococcus species, Microaerophilic streptococci, C. perferinges

Dosage & Administration Cap 5.Clindacin 300mg (AS A Clindamycin AS A Macrolides).

Dosage of Clindamycin Capsule:

Serious Infections: 150 mg-300 mg every six hours.
More severe infections: 300 mg-450 mg every six hours.

To avoid the possibility of oesophageal irritation, Clindacin capsules should be taken with a full glass of water.

Several researches has found that Clindamycin 300 mg capsule provides plasma concentration over MIC₉₀ for more than 12 hours. This finding supports the twice-daily dosing of Clindacin 300 mg capsule, particularly in SSTIs & RTIs. However, in case of bone & joint infections, diabetic foot infections dose of Clindamycin should be 300 mg capsule 3-4 times daily.

Dosage of Clindamycin Powder for oral solution:

Serious infections: 8-12 mg/kg/day divided into 3 or 4 equal doses.
Severe infections: 13-16 mg/kg/day divided into 3 or 4 equal doses.
More severe infections: 17-25 mg/kg/day divided into 3 or 4 equal doses.

In pediatric patients weighing 10 kg or less, 1/2 teaspoon (37.5 mg) three times a day should be considered the minimum recommended dose.

Dosage of Clindamycin IV/IM Injection:
Adults-

Serious infections due to aerobic gram-positive cocci and the more susceptible anaerobes: 600-1200 mg/day in 2- 4 equal doses.
More severe infections: 1200-2700 mg/day in 2-4 equal doses.
For more serious infections: these doses may have to be increased. In life-threatening situations due to either aerobes or anaerobes, these doses may be increased.
Doses of as much as 4800 mg daily have been given intravenously to adults. Single intramuscular injections of greater than 600 mg are not recommended.

Neonates (less than 1 month): 15 to 20 mg/kg/day in 3 to 4 equal doses. The lower effective dosage may be adequate for small prematures.

Pediatric patients (1 month of age to 16 years):

20 to 40 mg/kg/day in 3 or 4 equal doses. The higher doses would be used for more severe infections.
Parenteral therapy may be changed to Capsules (clindamycin hydrochloride) when the condition warrants and at the discretion of the physician.
In cases of (3-hemolytic streptococcal infections, treatment should be continued for at least 10 days.

Interaction Cap 5.Clindacin 300mg (AS A Clindamycin AS A Macrolides).

Clindacin enhances the action of other neuromuscular blocking agents. Therefore, it should be used with caution in patients receiving such agents. Antagonism has been demonstrated between Clindacin and erythromycin in vitro. Because of possible clinical significance, these two drugs should not be administered concurrently.

Contraindications

Clindamycin is contraindicated in patients previously found to be sensitive to clindamycin or any of the ingredients of this medicine.

Side Effects Cap 5.Clindacin 300mg (AS A Clindamycin AS A Macrolides).

The adverse effects have been reported with the use of Clindacin are- abdominal pain, oesophagitis and oesophagial ulcer, nausea, vomiting and diarrhoea, pruritus, skin rashes, urticaria.

Pregnancy & Lactation Cap 5.Clindacin 300mg (AS A Clindamycin AS A Macrolides).

Pregnancy Category B. Clindamycin crosses the placenta in humans. After multiple doses, amniotic fluid concentrations were approximately 30% of maternal concentrations. Clindamycin should be used in pregnancy only if clearly needed. Clindamycin has been reported to appear in breast milk. Therefore, it is not recommended for nursing mothers if not clearly needed.

Therapeutic Class Cap 5.Clindacin 300mg (AS A Clindamycin AS A Macrolides).

Macrolides

Recurrence এর ক্ষেত্রে Metronidazole Vaginal preparation টা লং টাইম ব্যবহার করা যেতে পারে

Note:- Avoid Metronidazole in 1st Trimester

________________________________________

𝐓𝐫𝐢𝐜𝐡𝐨𝐦𝐨𝐧𝐢𝐚𝐬𝐢𝐬

Sexual intercourse এর মাধ্যমে ট্রান্সমিট হয়,মহিলাদের vaginitis & পুরুষের urethritis করে থাকে

Dx clue on Examination ___

*পাতলা ,হলদাভ সবুজ ,frothy, Malodorous..Discharge

*Vaginal Inflammation থাকবে

*Itching

* Burning During micturation

Treatment ……………

Metronidazole (1st line)

TDS–7 দিন

Tinidazole 2gm once*

Suppository Gynepro**

Treat – সেস্কুয়াল পাটনার Also**

___________________________________

𝐂𝐚𝐧𝐝𝐢𝐝𝐚 𝐯𝐚𝐠𝐢𝐧𝐢𝐭𝐢𝐬

Most commonly Candida Albicans*

Sign Symtoms ___

•Thick “Cottage cheese” Discharge ****

• Vaginal Inflammation থাকবে

• Genital Burning *

Treatment

Pregnant হলে

Afun Vt tablt-
Vaginal Tablet 1.Afun –VT 200MG (As a Clotrimazole AS A Drugs used in Vaginal and Vulval condition, Topical Antifungal preparations.)

Indications of Vaginal Tablet 1.Afun –VT 200MG (As a Clotrimazole AS A Drugs used in Vaginal and Vulval condition, Topical Antifungal preparations.)

Afun VT rectal preparation is indicated in vaginal itching, burning and discharge associated with recurrent vaginal yeast infections (Vaginal candidiasis) and also in viginitis due to Candida species as well as Mycotic infections complicated by other microorganisms sensitive to the drug.

‘

Pharmacology Vaginal Tablet 1.Afun –VT 200MG (As a Clotrimazole AS A Drugs used in Vaginal and Vulval condition, Topical Antifungal preparations.)

Clotrimazole is a broad-spectrum antifungal agent that is used for the treatment of dermal infections caused by various species of pathogenic dermatophytes, yeasts, moulds and bacteroids. Clotrimazole is also active against certain gram-positive bacteria especially Staphylococci and Tricomonas. Like other imidazoles, Clotrimazole alters the permeability of fungal cell walls by interfering with cell wall lipids. At fungi static levels the main effect is inhibition of ergosterol synthesis but at higher concentrations there is an additional mechanism of membrane damage unrelated to sterol synthesis.

Dosage Vaginal Tablet 1.Afun –VT 200MG (As a Clotrimazole AS A Drugs used in Vaginal and Vulval condition, Topical Antifungal preparations.)

Clotrimazole 100 mg & 200 mg vaginal preparation-

First infections: In general, a 3-day treatment is sufficient for Candida vaginitis. On 3 consecutive nights, Clotrimazole 200 mg vaginal preparation is inserted as deeply as possible into the vagina. This is best achieved when lying on one’s back with the knees slightly bent.
Re-infections: In general, a 6-day treatment is sufficient. This applies also to mixed infections with the above-mentioned causative organisms. On six consecutive nights, 1 Clotrimazole 100 mg vaginal preparation is inserted as deeply as possible into the vagina. If necessary, 2 Clotrimazole 100 mg (1 in the morning and 1 in the evening) or 1 Clotrimazole 200 mg daily can be used for 6-12 days. Treatment should be timed so as to avoid the menstrual period and be finished before the onset of menstruation. To avoid re-infection, the partner should undergo local treatment with Clotrimazole cream at the same time.

Clotrimazole 500 mg vaginal preparation: Single dose, complete treatment with one vaginal tablet. The tablet should be inserted as deeply as possible into the vagina. This is best achieved when lying on one’s back with the knees slightly bent. It is recommended that the treatment should be timed so as to avoid the menstrual period. For prevention of re-infection the partner should be treated locally with Clotrimazole cream at the same time.

Clotrimazole vaginal preparation are colorless and do not stain the underwear.

Interaction

No information is available.

Contraindications

It is contraindicated in patients with known hypersensitivity to any of the components of this product.

Side Effects Vaginal Tablet 1.Afun –VT 200MG (As a Clotrimazole AS A Drugs used in Vaginal and Vulval condition, Topical Antifungal preparations.)

Since there is practically no Afun VT absorption through the vaginal skin, no systemic effect is expected. The local tolerance of Afun VT vaginal tablet is generally good. Local irritation or burning sensation may occur in a very few cases but these symptoms are not considered harmful.

Pregnancy & Lactation Vaginal Tablet 1.Afun –VT 200MG (As a Clotrimazole AS A Drugs used in Vaginal and Vulval condition, Topical Antifungal preparations.)

It is recommended that Clotrimazole should be used in pregnancy only when considered necessary by the physician. Clotrimazole is very poorly absorbed into the blood and the body after application to the skin or the vagina. Studies in women in their second or third trimesters have demonstrated no ill effects. It is not known if Clotrimazole is secreted in breast milk. Clotrimazole suppository can be used during pregnancy, but only under the supervision of Physician.

Therapeutic Class Vaginal Tablet 1.Afun –VT 200MG (As a Clotrimazole AS A Drugs used in Vaginal and Vulval condition, Topical Antifungal preparations.)

Drugs used in Vaginal and Vulval condition, Topical Antifungal preparations

৩ দিন ৩ টা মাসিকের রাস্তা দিয়ে দিবে

Recurnt এর ক্ষেত্রে ৫ দিন ৫টা দিবে, & পরে প্রতি সপ্তাহে 1টা করে —4 সপ্তাহ দিবে……

Non-Pregnant হলে

Capsule 6. Flugal 200mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Indications of Capsule 6. Flugal 200mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Flugal is indicated in-

Vaginal Candidiasis
Oropharyngeal Candidiasis
Esophageal Candidiasis
Tinea corporis/Tinea cruris/Tinea pedis/Other Tinea
Kerion
Pityriasis versicolor
Onychomycosis
Invasive candidal infections and cryptococcal infections (including meningitis)
Prevention of cryptococcal meningitis
Prevention of fungal infections in immunocompromised patients
Systemic Candidiasis and Cryptococcal infection
In Superficial Candidiasis
In Systemic Candidiasis & Cryptococcal infection

Other indications-

Fungal urinary tract infections
Disseminated candidiasis
Prophylaxis for fungal infection in neutropenic cancer patients.
Acute treatment of other systemic fungal infections such as coccidioidomycosis and histoplasmosis.

Pharmacology Capsule 6. Flugal 200mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Fluconazole is a triazole antifungal agent. It is a potent inhibitor of fungal cytochrome P-450 dependent enzymes. Cytochrome P-450 enzyme system is essential component of fungal cell membrane which is responsible for the synthesis of ergosterol.

Dosage & Administration Capsule 6. Flugal 200mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Adults:

Vaginal Candidiasis: 150 mg as a single dose.
Oropharyngeal Candidiasis: 200 mg in 1st day followed by 100 mg daily for 14 days.
Oesophageal Candidiasis: 200 mg in 1st day followed by 100 mg daily for 14-30 days.
Tinea corporis/Tinea cruris/Tinea pedis/Other Tinea: 150 mg weekly for 4-6 weeks.
Kerion: 50 mg daily for 20 days.
Pityriasis versicolor: 400 mg as a single dose.
Onychomycosis: 150 mg weekly for 12 months.
Invasive candidal infections and cryptococcal infections (including meningitis): Orally or by IV infusion, 400 mg on first day then 200-400 mg daily.
Prevention of cryptococcal meningitis: Orally or by IV infusion 200 mg daily.
Prevention of fungal infections in immunocompromised patients: Orally or by IV infusion, 50-400 mg daily.

Child over 1 year-

In Superficial Candidiasis: 1-2 mg/kg daily.
In Systemic Candidiasis & Cryptococcal infection:3-6 mg/kg daily.

In serious life threatening infections upto 12 mg/kg daily has been given to children aged 5-13 years (Maximum 400 mg daily)

1 year: 9 kg: 1/2 measuring spoonful
1-2 years: 12 kg: 1 measuring spoonful
2-3 years: 14 kg: 1½ measuring spoonful
3-4 years: 16 kg: 2 measuring spoonful
4-6 years: 20 kg: 2½ measuring spoonful

Use in Specific Population-

Elderly patient: The normal dose should be used if there is no evidence of renal impairment.

Renal Impairment: No adjustment in single dose therapy is required. In multiple dose therapy of patients with renal impairment, normal doses should be given on days 1 and 2 of treatment and there after the dosage intervals should be modified as follows:

Creatinine clearance (>41 ml/min): Dosage interval (hours) 24
Creatinine clearance (21-40 ml/min): Dosage interval (hours) 48
Creatinine clearance (10-20 ml/min): Dosage interval (hours) 72
Patients receiving regular dialysis: One dose after every dialysis session

Children: Renal clearance in children may be proportionately more rapid than in adults and doses up to 12 mg/kg is recommended.

Side Effects Capsule 6. Flugal 200mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Flugal is generally well tolerated. The commonest side-efects associated Flugal are symptoms associated with the gastrointestinal tract; these include nausea, abdominal discomfort, diarrhoea and fatulence. Other adverse events such as rash are rarely encountered (Incidence less than 1%). In rare cases, as with other azoles, anaphylaxis has been reported.

Pregnancy & Lactation

Fluconazole adverse fetal efects have been seen in animals only at dose levels associated with maternal toxicity. These levels are many times in excess of those recommended for therapeutic use. There has been little use during human pregnancy. Accordingly, fuconazole should not be used in pregnancy or in women of child bearing potential unless adequate contraception is employed.

Therapeutic Class Capsule 6. Flugal 200mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Drugs for subcutaneous and mycoses

0+0+1—5 দিন

+ Antifungal Cream**

Cream 8.Xfin 1% 10gm Tube AS A Terbinafine Hydrochloride AS A Other Antifungal preparations, Topical Antifungal preparations.

চুল্কানি থাক্লে Antihistamine **
Tablet 9. Fexo 120mg (AS A Fexofenadin AS A Non-sedating antihistamines).

Recurnt এর ক্ষেত্রে

Mx হবে

Fluconazol 150 mg একটা ট্যাবলেট, ৩ দিন পরপর মোট ৩ ডোজ,

তারপরে প্রতি সপ্তাহে 1 টা করে Tab- Flugal 150 mg করে একটানা ৬ মাস চলবে..

______________________________

Advice

Avoid Metronidazole in 1st Trimester *

অবিবাহিত দের vaginal Suppository দেওয়া থেকে বিরত থাকুন

Avoid Intercourse During ট্রিটমেন্ট

Pregnancy Oral এন্টি ফাংগাল দিবেন না,Vaginal preparation দিবেন

******

VT দিয়ে আবশই শুয়ে থাকেবে

দরকার হলে রাত ১২ টায় দিবে ,দিয়ে শুয়ে থাকবে ;;উঠার দরকার নেই

দিয়ে ঘুমিয়ে যাবে ;;sexual intercourse থেকে বিরত থাকবে

আস্তে আস্তে গলে গলে কাজ করবে নিজে নিজেই,

সকালে washroom এ গেলে সাদা সাদা কিছু বের হতে পারে ,,এইটা কোনো সমস্যা নয় নরমাল……

Personal heigyn মেনে চলবে…..

Period এর সময় use করবে না….হয় period এর পর….

না হয় period এর ১০-১৫ দিন আগেই করবে……

[ Mainly married দের দেওয়া হয়

Unmarried দের দেয়া হয়না

Fungal + Becteria coverage infection এ supp Gynepro]

Only Fungal— Afun vt

E sara o amra multi drug hisebe ar akta drug dite pari

seta holo

General Quaries:

1 Amra to gynomix/ v cap vaginal suppository o sathe suggest kori tai na?

Answer is: Yes pari use Korte .

Vaginal suppository 1: Gynomix (As A Metronidazole+Neomycin sulfate+Polymyxin B+Nystatin As A drugs used in vaginal and Vulval condition.)

Indications:-

Gynomix is indicated in-

Vaginal trichomoniasis

Vaginal leucorrhoeas

Mixed vaginal infections (Fungal or Bacterial).

Thanks

Raiyyan Tahsan. Date:-20-01-2025 Monday Time:-12-01.25 Pm

Raiyyan Tahsan

Raiyyan Tahsan