Patient Care and Monitoring of Mycotic Infections

1. Assess the patient's symptoms to determine if self-treatment with OTC antifungal therapy is appropriate or whether the patient should be evaluated by a practitioner. Exclusions for self-treatment include infection of nails or hair, unsuccessful initial treatment, worsening condition, signs of secondary bacterial or systemic infection, large infected areas, or chronic medical conditions such as diabetes, immunosup-pression, or impaired circulation.

2. Review any available diagnostic data, including cultures and KOH preps.

3. Obtain a thorough history of prescription, nonprescription, and natural drug product use.

4. If the patient has had a mycotic infection previously, determine what treatments were helpful to the patient in the past.

5. Educate the patient on lifestyle modifications that will prevent recurrence, which includes keeping the area dry, wearing shower shoes, washing clothing in hot water, using drying powders, avoiding sharing of towels or clothing, and wearing loose-fitting clothing.

6. Develop a plan to assess effectiveness of antifungal therapy.

7. Determine if long-term prophylactic therapy is necessary to prevent recurrence.

8. Evaluate the patient for the presence of adverse drug reactions, drug allergies, and drug interactions.

9. Stress the importance of adherence with the antifungal regimen.

10. Provide the patient education pertaining to mycotic infections and antifungal therapy.

• Causes of mycotic infections of the skin, hair, or nails

• Different types of OTC antifungal products, such as creams, sprays, shampoos, ointments, gel, lotions, solutions, and powders

• How to apply various OTC antifungal products

• How long therapy should be continued

• How to avoid spread of infection

• How to avoid recurrent infection

• Potential adverse effects that may occur with antifungal therapy

Dietary modifications that are necessary with oral agents

• Medications that may interact with antifungal therapy, particularly with oral agents used for nail infections

• Warning signs to report to a physician (recurrent or difficult-to-cure infections, infections with malodorous discharge or bleeding)

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