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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

KETOCONAZOLE

Indication

  • the treatment of susceptible fungal infections including oral and mucocutaneous candidiasis (NYSTATIN IS OUR FIRST CHOICE)

Pharmacology

  • ketoconazole is a synthetic antifungal agent that is active against most pathogenic fungi
  • believed to act by inhibition of sterol synthesis, resulting in disruption of the fungal membrane
  • gastric acidity is essential for dissolution and absorption of ketoconazole; therefore, ensure that at least 2 hours separate the administration of ketoconazole and antacids or H2-blockers (eg. cimetidine, ranitidine)
  • poor penetration into the CSF

Side Effects

  • transient increases in liver enzymes
  • GI: vomiting, pain, diarrhea
  • pruritus, rash, irritation with topical use
  • gynecomastia, decrease in basal and ACTH-induced cortisol levels

Drug Interactions

  • ketoconazole may cause serum concentration of phenytoin, theophylline and caffeine to increase

Dose

  • oral - 2.5 to 5 mg/kg po q12h
  • topical - apply once to twice daily

Supplied

  • 20 mg/mL suspension
  • 2% cream

References

  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
  3. Krogh CME et al (ed): Compendium of Pharmaceuticals and Specialties, Canadian Pharmaceutical Association, 1992.
  4. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.



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