Fungal Infections - Tackling the Threat with Econazole

Overview:

Econazole is a newly developed antifungal medication belonging to the imidazole class. It shares a similar chemical structure with another imidazole derivative called Miconazole. Econazole is primarily used in the form of a nitrate salt for local application, although there have been preliminary investigations into its systemic use, with a few patients receiving oral or intravenous administration of Econazole base.

Numerous uncontrolled studies have been conducted using Econazole nitrate topically to treat dermatomycoses caused by various fungi, as well as vaginally to treat vaginal candidiasis. However, there is a lack of controlled therapeutic trials comparing Econazole with other antifungal drugs in the treatment of skin mycoses, and it has only been compared to Nystatin in a limited number of patients with vaginal candidiasis. Therefore, the exact position of Econazole in the treatment of dermatomycoses and vaginal candidiasis, in comparison to traditional antifungal agents and other imidazole derivatives like Miconazole or Clotrimazole, cannot be definitively stated until sufficient comparative studies are conducted.

How Does Econazole Work?

Econazole is an antifungal medication that works by inhibiting the growth and spread of fungal organisms. It belongs to the class of drugs known as imidazole antifungals. The exact mechanism of action of Econazole involves its interaction with the cell membranes of fungal cells.

Econazole functions by inhibiting the synthesis of ergosterol. It is a component of the cell membranes of the fungus. Ergosterol plays a crucial role in maintaining the structural integrity and function of fungal cells. By interfering with the synthesis of ergosterol. Econazole disrupts the fungal cell membrane's structural integrity, which results in heightened permeability and the release of cellular contents. This disruption ultimately impairs the growth and replication of the fungal organism. Econazole also interferes with the activity of enzymes called cytochrome P450-dependent enzymes, which are involved in the synthesis of important compounds within fungal cells. By inhibiting these enzymes, Econazole disrupts the production of vital substances necessary for the survival and growth of fungi.

Uses:

Econazole is commonly used to treat various skin infections, including athlete's foot (tinea pedis), jock itch (tinea cruris), sun fungus (tinea versicolor), yeast infection of the skin (cutaneous candidiasis) and ringworm (tinea corporis). These infections are caused by different types of fungi that can thrive on the skin's surface, leading to symptoms such as itching, redness, inflammation, and the formation of a characteristic rash. When Econazole is applied topically to the affected areas, it works by directly targeting the fungal organisms responsible for the infection. The medication penetrates the skin and reaches the site of the fungal growth. Once there, it acts by inhibiting the growth and replication of the fungi, ultimately leading to their elimination.

Econazole's antifungal properties help to alleviate the symptoms associated with these skin infections and promote the healing process. It is important to follow the prescribed treatment regimen and continue using the medication for the recommended duration, even if the symptoms improve or disappear before the treatment is completed. This ensures that the infection is fully eradicated and reduces the risk of recurrence.

Dosage Forms:

• Foam.

• Cream.

For Patients

Learn About Fungal Infections

Fungi exist in various environments, including the soil, air, plants, and water. Some fungi also inhabit the human body. It is worth noting that only around half of all types of fungi are harmful to humans. Fungi have a unique mode of reproduction, often involving the release of tiny spores into the air. These spores can be inhaled or come into contact with the skin. Consequently, fungal infections frequently originate in the lungs or on the skin. Eliminating fungi can be challenging. In the case of skin and nail infections, topical antifungal medications can be applied directly to the affected area. In more severe infections, oral antifungal medicines are available for systemic treatment.

Which Fungal Infections Does Econazole Treat?

• Ringworm - Ringworm, also known as dermatophytosis, is a common fungal infection of the skin. Despite its name, it is not caused by a worm but by various species of fungi known as dermatophytes. Ringworm typically appears as a red, circular rash with raised edges and a clear center, resembling a ring. It can affect different parts of the body, including the scalp, body, groin (jock itch), feet (athlete's foot), and nails. The infection exhibits a high level of contagion and can be transmitted through direct contact with an afflicted individual, animals, or contaminated items like clothing, towels, or surfaces. Symptoms of ringworm may include itching, redness, scaling, and sometimes blistering or oozing of the skin. In the case of scalp ringworm, hair loss or bald patches may occur.

• Athlete's Foot - This condition, also referred to as tinea pedis, is a fungal infection that typically initiates in the spaces between the toes. It commonly affects individuals whose feet perspire excessively while being enclosed in tight shoes. Typical symptoms of an athlete's foot include an itchy and scaly rash. The infection is contagious and can spread through contact with contaminated floors, towels, or clothing. Athletes' feet are closely linked to other fungal infections like ringworm and jock itch. While antifungal medications can be used to treat the condition, there is a tendency for the infection to recur.

• Jock Itch - It is also known as tinea cruris and is a prevalent fungal infection that resembles ringworm. It results in an itchy, stinging, and burning rash on the skin surrounding the groin, inner thighs, and buttocks (gluteal cleft). The term "tinea cruris" is used interchangeably with jock itch, where "tinea" refers to ringworm and "cruris" indicates the groin area. In addition to itchiness and discomfort, jock itch can lead to scaling, cracking of the skin, and the formation of bumps or blisters.

• Sun Fungus -The fungus Malassezia is a yeast commonly found on the surface of the skin. Normally, it does not pose any health concerns. In fact, many of the microbes, including yeasts like Malassezia, that exist in large communities on the skin play a role in protecting the body from infections and pathogens that can be harmful.

These microscopic organisms coexist with the body's cells in a symbiotic relationship, where the skin cells and tiny organisms support and benefit each other. However, there are instances when this yeast can overgrow and impact the natural pigmentation of the skin. As a result, this can lead to the formation of skin patches that exhibit either a lighter or darker tone compared to the surrounding skin. This non-contagious condition is known as tinea versicolor or pityriasis versicolor.

Learn More About Econazole

Before Starting Econazole

• Kindly inform the doctor and pharmacist regarding any allergies to Econazole or other drugs.

• Share with the doctor and pharmacist a comprehensive list of ongoing medications, including prescription and non-prescription drugs, as well as any vitamin supplements.

• In case of pregnancy, plans to become pregnant, or breastfeeding, it is important to notify the doctor.

How Effective Is Econazole?

Econazole nitrate has proven to be an effective antifungal medication. In dermatological studies, approximately 90 percent of patients achieved a cure, often within a relatively short treatment period of two to six weeks, which is consistent with other imidazole antifungal agents. The cure rate for patients with severe mycoses lasting many years was only slightly lower (around 85 percent) compared to those with more recent infections. In the case of vaginal candidiasis, a three-day treatment regimen using a daily dose of 150 milligrams (mg) suppository showed slightly lower effectiveness (85 percent mycological cure rate) compared to a 15-day regimen using a daily 50 mg dose of suppository or cream (90 percent cure rate). In a small group of patients with vaginal candidiasis, a three to five-day 'higher' dose regimen with Econazole was slightly more effective than the standard 15-day regimen of Nystatin vaginal inserts. The convenience of the higher-dose, shorter-term regimen would likely be advantageous for most patients. However, whether other agents used for vaginal candidiasis would be equally effective if administered in a similar manner as Econazole remains undetermined. In general, topical or intravaginal administration of Econazole nitrate has been well tolerated, with side effects limited to local irritation reported in approximately one to four percent of patients in most studies.

Things to Tell Physicians Before They Prescribe Econazole:

• Inform the doctor if symptoms do not show improvement within two to four weeks or if they worsen.

• Inform the doctor if there are developed sores or blisters that do not heal properly. If the skin infection returns after discontinuing the use of this medication, contact the doctor.

• For jock itch treatment, avoid wearing tight-fitting or synthetic fiber underwear, such as rayon or nylon. Opt for loose-fitting cotton underwear instead. Ensure thorough drying of the affected area after bathing.

• When using this medication for an athlete's foot, ensure proper drying of the feet, especially between the toes, after bathing. Avoid wearing socks made of wool or synthetic materials like rayon or nylon. Instead, opt for clean cotton socks and replace them daily or more often if the feet tend to perspire excessively. Consider wearing well-ventilated sandals or shoes.

• To keep the skin dry, apply an absorbent powder, such as talcum powder or antifungal powder, to the affected skin between applications of this medication.

• Please note that treatment with this medication for tinea versicolor (sun fungus) will not immediately restore normal skin coloration. It may take a few months for the skin's appearance to improve.

Starting Econazole

How to Use Econazole?

• Econazole is available in the form of a cream that is applied to the skin. Typically, Econazole is used once or twice a day, in the morning and evening, for a duration of two weeks.

• In some cases, certain infections may require a treatment period of up to six weeks. If there is any part that is not understood, seek clarification from the doctor or pharmacist. Use Econazole exactly as directed, avoiding using more or less of it or applying it more frequently than prescribed by the doctor.

• Prior to applying the medication, ensure to clean the infected area thoroughly, let it dry, and then delicately massage the medication until it is mostly absorbed. Apply an appropriate amount of medication to cover the affected area. Remember to wash one’s hands after applying the medication.

• Even if one feels better, it is essential to continue using Econazole as prescribed. Do not discontinue the use of Econazole without consulting the doctor.

Look Out for the Side Effects:

Econazole has the potential to cause side effects. It includes-

• Burning sensation.

• Itching.

• Irritation.

• Redness.

• Stinging.

• Rash.

For Doctors

• Indication: Econazole is a specific kind of antifungal medication designed for topical application to the skin, used for the treatment of various fungal infections. It is specifically used to address conditions such as cutaneous candidiasis (skin yeast infection), tinea cruris (jock itch), tinea pedis (athlete's foot), tinea corporis (ringworm), and tinea versicolor (a fungal infection that causes patches of discolored skin).

Pharmacology:

• Mechanism of Action: Econazole acts by interacting with an enzyme called 14-α demethylase, which is a cytochrome P-450 enzyme required for converting lanosterol and ergosterol. Ergosterol plays a vital role in the structure of the fungal cell membrane. By inhibiting its synthesis, Econazole increases the permeability of fungal cells, leading to the leakage of cellular contents. Additionally, Econazole may hinder endogenous respiration, interact with membrane phospholipids, impede the transformation of yeasts into mycelial forms, hinder purine uptake, and disrupt the biosynthesis of triglycerides and phospholipids.

• Pharmacokinetics: Econazole is distributed within the body. While there is limited information available on the systemic distribution of econazole following topical application, it is expected to have minimal systemic absorption. Therefore, its distribution is mainly localized to the site of the application.

• Pharmacodynamics: Econazole belongs to a class of antifungal medications that include Fluconazole, Ketoconazole, Itraconazole, and Clotrimazole. Econazole is specifically effective against fungal infections and will not be effective for treating bacterial or viral infections.

• Absorption: When Econazole nitrate is applied topically to the skin of healthy individuals, the amount of the drug absorbed into the bloodstream is very minimal. While most of the applied medication remains on the skin's surface, traces of the drug can be identified in the outermost skin layer, known as the stratum corneum. These concentrations of the drug are significantly higher than the minimum inhibitory concentration required to effectively combat dermatophytes, which are a type of fungi that cause skin infections.

• Metabolism: Econazole undergoes hepatic metabolism, which means that it is primarily metabolized in the liver. The detailed metabolic pathways and the specific enzymes involved in the metabolism of Econazole have not been extensively researched or well-documented.

• Elimination: The elimination of Econazole from the body primarily occurs through hepatic metabolism and subsequent excretion in the feces. After undergoing metabolism in the liver, the resulting metabolites of Econazole are eliminated from the body through the bile into the gastrointestinal tract. From there, they are ultimately excreted in the feces.

Renal excretion (excretion of Econazole or its metabolites in the urine) is believed to be a minor pathway for elimination. However, the exact extent and significance of renal excretion in the elimination of Econazole have not been extensively studied or well-documented.

Contraindications:

• Hypersensitivity: Individuals with known hypersensitivity or allergic reactions to Econazole or any of its components should avoid its use. Allergic reactions can encompass a spectrum of responses, ranging from mild skin irritation to severe hypersensitivity reactions, including the potentially life-threatening condition known as anaphylaxis.

• Ophthalmic Use: Econazole is primarily intended for topical use on the skin, nails, and mucous membranes. It should not be used directly in the eyes. If ocular involvement is present or suspected, a specific ophthalmic formulation or alternative treatment should be considered.

Warnings and Precautions:

• Avoid using this medicine for a skin problem without first consulting the doctor for proper evaluation.

• If the skin problem does not show improvement within two weeks or if it worsens, seek advice from the doctor.

• Contact the doctor immediately in case of experiencing a skin rash, burning, stinging, swelling, redness, or irritation.

• In addition to using the medicine, practicing good health habits is crucial to fully clear up the infection and prevent its recurrence.

Patients using the cream to treat athlete's foot can maintain cool and dry feet by doing the following:

• Avoid wearing wool or synthetic material socks (such as rayon or nylon). Instead, opt for clean, cotton socks and change them daily or more frequently if the feet perspire heavily.

• Choose sandals or well-ventilated shoes (with holes) whenever possible.

• Apply a gentle, absorbent powder on the feet, between the toes, and inside socks and shoes once or twice a day. It is recommended to use the powder in between applications of the cream.

Drug Interactions:

Combining Econazole with certain medications may result in drug interactions that can impact their effectiveness or increase the risk of side effects. For instance, the serum concentration of Adagrasib, Asciminib, Atogepant, and Clozapine may be increased when used concomitantly with Econazole. This means that the levels of these medications in the bloodstream may rise, potentially leading to an increased therapeutic effect or an elevated risk of adverse reactions. On the other hand, the metabolism of Alfuzosin, Avanafil, Bortezomib, Bromocriptine, Cabergoline, and Cariprazine may be decreased when combined with Econazole, potentially resulting in lower drug clearance and increased concentrations.

Other Specifications:

• Econazole During Pregnancy: When it comes to the use of Econazole during pregnancy, consult with a doctor. While there is limited information available on the specific risks of Econazole use during pregnancy, it is generally recommended to avoid unnecessary medication during this time, especially during the first trimester when fetal development is critical.

• Breastfeeding and Econazole: If Econazole is prescribed, it is generally advised to avoid applying it to the breast area to minimize direct exposure to the nursing infant.

• Econazole in Geriatric Patients: Elderly individuals are at risk due to age-related changes in their body's metabolism and elimination processes.