Miconazole (Topical)

INTRODUCTION

Indications

Treatment of a variety of cutaneous fungal infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), tinea corporis (ringworm). Treatment of vulvovaginal candidiasis.

Action

Affects the synthesis of the fungal cell wall, allowing leakage of cellular contents. Therapeutic Effects: Decrease in symptoms of fungal infection.

Adverse Reactions/Side Effects

Local: burning, itching, local hypersensitivity reactions, redness, stinging.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor symptoms and healing of skin lesions to help document drug effectiveness.

Interventions

• Avoid contact with cutaneous lesions when treating patient.

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection.

Patient/Client-Related Instruction

• Advise patient to report any increased local sensitivity to this drug (pain, burning, itching, swelling).

• Instruct patient about proper hygiene; e.g., thoroughly wash and dry the affected area, wear clean socks and ventilated shoes for tinea pedis, and so forth.

• Advise patient to apply the drug as directed for the full course of treatment, even if feeling better.

• Inform patient that early relief of cutaneous symptoms may be seen in 2–3 days. Full therapeutic response may take 2 wk for tinea cruris and tinea corporis and 3–4 wk for tinea pedis.

• Vaginal infections: therapeutic response is usually seen after 1 wk. Therapy should be continued during menstrual period.

• Advise patient to seek medical help if infections persist or recur after the full treatment. Recurrent fungal infections may be a sign of systemic illness.

Pharmacokinetics

Absorption: Absorption through intact skin is minimal.

Distribution: Distribution after topical administration is primarily local.

Metabolism and Excretion: Systemic metabolism and excretion not known following local application.

Half-life: Not applicable.

Contraindications/Precautions

Contraindicated in: Hypersensitivity to active ingredients, additives, preservatives, or bases; Some products contain alcohol or bisulfites and should be avoided in patients with known intolerance.

Use Cautiously in: Nail and scalp infections (may require additional systemic therapy); OB/Lactation: Safety not established.

Interactions

Drug-Drug: Not known.

Route/Dosage

Topical (Adults and Children >2 yr): Apply twice daily. Treat patients with tinea cruris for 2 wk and ...