What Is Clotrimazole?

Clotrimazole is a broad-spectrum antifungal drug, which has a good antibacterial effect on a variety of fungi, especially Candida albicans, and its mechanism of action is to inhibit the synthesis of fungal cell membranes and affect its metabolic process. It has antibacterial effect on superficial fungi and some deep fungi. Clinically, it is mainly used externally to treat dermatomycosis, such as ringworm, tinea corporis, ear canal, and vaginal mycosis. This product is highly toxic, and may cause gastrointestinal reactions, abnormal liver function, and leukopenia. It is now used sparingly. There are no adverse reactions to external use, and occasional local inflammation. There are 1% to 3% creams and suppositories for external use.

Clotrimazole is a broad-spectrum antifungal drug, which has a good antibacterial effect on a variety of fungi, especially Candida albicans, and its mechanism of action is to inhibit the synthesis of fungal cell membranes and affect its metabolic process. It has antibacterial effect on superficial fungi and some deep fungi. Clinically, it is mainly used externally to treat dermatomycosis, such as ringworm, tinea corporis, ear canal, and vaginal mycosis. This product is highly toxic, and may cause gastrointestinal reactions, abnormal liver function, and leukopenia. It is now used sparingly. There are no adverse reactions to external use, and occasional local inflammation. There are 1% to 3% creams and suppositories for external use.
Drug Name
Clotrimazole
Alias
Tribenzimidazole, antifungal
Foreign name
Clotrimazole
Function
Broad-spectrum antifungal effect
Molecular formula
C22H17CLN2
Molecular weight
344.84

Clotrimazole compounds

Clotrimazole Basic Information

Chinese name: Clotrimazole
Chinese alias: tritylchlorometidazole; 1-[(2-chlorophenyl) diphenylmethyl] imidazole; 1-[(o-chlorophenyl) diphenylmethyl] imidazole; 1-((2-chloro Phenyl) diphenylmethyl) -1H-imidazole; 1- (2-chlorotrityl) imidazole; Antifungal No. 1; clobenzimidazole; chlorotribenzimidazole; chlorotribenzimidazole; triphenylbenzene Memidazole
English name: clotrimazole
English alias: 1-[(2-Chlorophenyl) diphenylmethyl] imidazole; 1-[(2-chlorophenyl) -diphenylmethyl] imidazole; 1- (2-chlorotrityl) imidazole; 1- (o-Chlorotrityl) imidazole, 1- (o -Chl; 1-[(2-chlorophenyl) diphenylmethyl] -1H-imidazole
CAS number: 23591-75-1
EINECS: 245-764-8
Molecular formula: C 22 H 17 ClN 2
Molecular weight: 344.83700
Exact mass: 344.10800
PSA: 17.82000
LogP: 5.37670 [1]

Clotrimazole physical and chemical properties

Appearance and properties: odorless, white powder or colorless crystalline powder is soluble in absolute ethanol, acetone, chloroform, and almost insoluble in water. Odorless, odorless, decomposes quickly in acid solutions. Clotrimazole hydrochloride, mp 159 ° C.
Density: 1.13g / cm 3
Melting point: 147-149ºC
Boiling point: 482.3ºC at 760mmHg
Flash point: 245.5ºC
Refractive index: 1.616
Storage conditions: Store at RT.
Vapor pressure: 5.42E-09mmHg at 25 ° C [1]

Clotrimazole Safety Information

Symbol: GHS07
Signal Word: Warning
Hazard statement: H302
Cautionary statement: P301 + P312 + P330
Customs Code: 2933290012
WGK Germany: 3
Danger category code: R22
Safety instructions: S26; S36
RTECS number: NI4377000
Dangerous goods mark: Xn [1]

Clotrimazole production method

Derived from o-chlorobenzoic acid through esterification, addition, hydrolysis, chlorination, and condensation. Orthochlorotoluene can be obtained by chlorination from o-chlorotoluene, and then condensed with benzene in the presence of aluminum trichloride to form diphenyl- (2-chlorophenyl) chloromethane, and finally condensed with imidazole to obtain clotrimazole [ 1] .

Clotrimazole uses

Antifungal skin medication for the treatment of deep and shallow mycosis caused by sensitive bacteria. Such as cryptococcal meningitis, candida pneumonia, enteritis, histoplasmosis, body ringworm, hand, foot and ringworm. Among them, the treatment of candidiasis is the best, but it is not effective for tinea capitis, whether it is applied externally or internally [1] .

Clotrimazole Pharmacopoeia Standard

Clotrimazole source (name), content (potency)

This product is 1-[(2-chlorophenyl) diphenylmethyl] -1H-imidazole. Calculated on dry basis, containing C22H17ClN2 shall not be less than 98.5%.

Clotrimazole traits

This product is white to slightly yellow crystalline powder; odorless and tasteless.
This product is easily soluble in methanol or chloroform, soluble in ethanol or acetone, and almost insoluble in water.
Melting point
The melting point of this product (Appendix VIC of Part Two of the 2010 Pharmacopoeia) is 141 to 145 ° C.

Clotrimazole identification

(1) Take an appropriate amount of this product, add dichloromethane to dissolve and dilute it to make a solution containing 5mg per 1ml, as a test solution; take another clotrimazole reference substance to dissolve and dilute to make 1ml It contains about 5 mg of the solution as a reference solution. According to the thin layer chromatography (2010 edition Pharmacopoeia Part II Appendix VB) test, draw 10 l each of the test solution and the reference solution, point on the same silica gel G thin layer plate, use isopropyl ether as the developing agent, and in the developing cylinder Place in a small beaker filled with concentrated ammonia solution to saturate, unfold, dry, and develop color in iodine vapor. The position and color of the main spots displayed by the test solution should be the same as the main spots of the reference solution [2] .
(2) Take about 10mg of this product, after adding 1ml of sulfuric acid to dissolve, it will be orange-yellow; after diluting with 3ml of water, the color will disappear; and then add 3ml of sulfuric acid, it will return to orange-yellow.
(3) The infrared light absorption spectrum of this product should be consistent with the control spectrum (Figure 169 of "Infrared Spectra of Drugs").

Clotrimazole check

Imidazole
Take this product and add chloroform to make a solution containing about 100mg per 1ml as the test solution; take another imidazole reference product and add chloroform to make a solution containing about 0.50mg per 1ml as the reference Solution. According to the thin-layer chromatography (2010 edition Appendix II B) test, draw 5 l of each of the two solutions, point them on the same silica gel G thin-layer plate, and use xylene-n-propanol-concentrated ammonia solution (180: 20: 1) is a developing agent, develop, dry, and develop color in iodine vapor. The color of the test solution, if it shows impurities spots corresponding to the reference solution, must not be darker than the main spots of the reference solution (0.5%).
relative substance
Take this product, weigh it accurately, add 70% methanol to dissolve and quantitatively dilute it to make a solution containing about 0.2mg per 1ml as the test solution; take 1ml of the test solution precisely and place it in a 100ml measuring bottle. 70% methanol was diluted to the mark, and shaken as a control solution. Also take an appropriate amount of diphenyl- (2-chlorophenyl) methanol (impurity I) reference substance, accurately weigh it, and quantitatively dilute it with 70% methanol to make a solution containing about 1 g per 1 ml as the reference solution. Another appropriate amount of clotrimazole reference, impurity I reference and imidazole reference was diluted with 70% methanol to make a solution containing 0.04mg, 0.03mg and 0.05mg per 1ml, as a system suitability test solution. Tested according to high performance liquid chromatography (Appendix D of Part Two of the Pharmacopoeia 2010), using octadecylsilane bonded silica as a filler; methanol-0.05mol / L potassium dihydrogen phosphate solution (7: 3) ( Use 10% phosphoric acid to adjust the pH to 5.7 5.8) as the mobile phase; the detection wavelength is 215nm. Take 10 l of the system suitability test solution, inject it into the liquid chromatograph, and record the chromatogram. The theoretical plate number is calculated to be not less than 4000 based on the clotrimazole peak. The resolution of the clotrimazole peak and the impurity peak should be greater than 2.0. Take 20l of the reference solution and inject it into the liquid chromatograph to adjust the detection sensitivity so that the peak height of the main component is about 20% of the full scale. Precisely measure 20 l each of the test solution, the control solution and the reference solution, and inject them into the liquid chromatograph respectively, and record the chromatogram to 2.5 times the peak component retention time. If the chromatogram of the test solution has chromatographic peaks consistent with the retention time of impurity I, calculate the peak area according to the external standard method, and the impurity should not exceed 0.3%; except for the imidazole peak and impurity I peak in the chromatogram of the test solution In addition, the sum of the peak areas of other impurities should not be greater than 0.25 times (0.25%) of the main peak area of the control solution. [2]
Loss on drying
Take this product and dry it at 105 to constant weight, and the weight loss shall not exceed 0.5% (Appendix L of Part Two of the Pharmacopoeia of 2010 Edition).
Residue on ignition
Take 1.0g of this product and check it according to law (Appendix N of Part Two of the 2010 Pharmacopoeia). The residual residue shall not exceed 0.1%.
Heavy metal
Take the residue left under the item of burning residue and check it according to law (Appendix H of the second edition of the Pharmacopoeia of 2010 Edition, the second method H), the content of heavy metals must not exceed 20 parts per million.

Clotrimazole determination

Take 0.3g of this product, accurately weigh, add 20ml of glacial acetic acid to dissolve, add 1 drop of crystal violet indicator solution, titrate with perchloric acid titration solution (0.1mol / L) until the solution becomes blue-green, and use the titration result with Blank test correction. Each 1ml of perchloric acid titration solution (0.1mol / L) is equivalent to 34.48mg of C 22 H 17 ClN 2 [2] .

Clotrimazole category

Antifungal.

Clotrimazole storage

Shaded, sealed and stored in a cool place.

Clotrimazole

(1) Clotrimazole oral film (2) Clotrimazole cream (3) Clotrimazole film (4) Clotrimazole suppository (5) Clotrimazole solution (6) Clotrimazole betamethasone cream (7) Compound clotrimazole cream [2]

Clotrimazole Drug Analysis

Method name: Clotrimazole Membrane-Determination of Clotrimazole-Neutralization Titration
Application range: This method uses the titration method to determine the content of clotrimazole in the clotrimazole film.
This method is suitable for the determination of clotrimazole in clotrimazole film.
Principle of the method: take the test sample and dissolve it with chloroform, add water, dilute sulfuric acid and dimethyl yellow-solvent blue 19 mixed indicator liquid, titrate with sodium octyl sulfosuccinate test solution to the chloroform layer from green It turns red and gray; another reference sample is accurately weighed and measured in the same way, and calculated according to the ratio of the volume of the two octyl sodium sulfosuccinate test solutions consumed.
Reagent: 1. Water (newly boiled to room temperature)
2.Trichloromethane
3. Dilute sulfuric acid
4. dimethyl yellow-solvent blue 19 mixed indicator liquid
5. Dioctyl sodium sulfosuccinate
Equipment: 1. Dilute sulfuric acid
Take 57mL of sulfuric acid and dilute to 1000mL with water.
2 dimethyl yellow-solvent blue 19 mixed indicator liquid
Take 15 mg of each of dimethyl yellow and solvent blue 19, and add 100 mL of chloroform to dissolve.
3. Dioctyl sodium sulfosuccinate
Take 0.9 g of sodium dioctyl sulfosuccinate, add 50 mL of water, dissolve at a slight temperature, cool to room temperature, and dilute to 200 mL with water to obtain.
Sample preparation: 1. Dilute sulfuric acid
Take 57mL of sulfuric acid and dilute to 1000mL with water.
2. dimethyl yellow-solvent blue 19 mixed indicator liquid
Take 15 mg of each of dimethyl yellow and solvent blue 19, and add 100 mL of chloroform to dissolve.
3. Dioctyl sodium sulfosuccinate
Take 0.9 g of sodium dioctyl sulfosuccinate, add 50 mL of water, dissolve at a slight temperature, cool to room temperature, and dilute to 200 mL with water to obtain.
Operation steps: Take 2 test samples, accurately weigh, cut into pieces, accurately weigh an appropriate amount (approximately 50mg of clotrimazole), put in a conical flask with a stopper, and add 20mL of chloroform to dissolve clotrimazole. Add 20mL of water, 5mL of dilute sulfuric acid and 0.4mL of dimethyl yellow-solvent blue 19 mixed indicator solution. Titrate with dioctyl sodium sulfosuccinate test solution. Shake vigorously to the end, and continue the titration until the chloroform layer is changed from The green color changes to red-gray; another 50 mg of clotrimazole reference is accurately weighed and measured in the same way. It is calculated based on the volume (mL) of the two octyl sodium sulfosuccinate test solutions.
Note: "Precise weighing" means that the weighed weight should be accurate to one thousandth of the weighed weight. "Precision weighing" means that the accuracy of the measured volume should meet the accuracy of the pipette in the national standard Requirement [3] .

Clotrimazole drug description

Clotrimazole Pharmacology and Toxicology

Clotrimazole is a pyrrole broad-spectrum antifungal. It has a significant inhibitory effect on Trichophyton rubrum, Trichophyton gypsum, Cryptococcus neoformans, Aspergillus, Algae, Candida albicans, etc. The product inhibits the biosynthesis of sterols such as ergosterol by interfering with the activity of cytochrome P-450, damages the cell membrane of the fungus and changes its permeability, leading to the leakage of important intracellular substances; it can inhibit the triglycerides of the fungus Biosynthesis of lipids and phospholipids; it can also inhibit the activity of oxidase and peroxidase, causing the accumulation of hydrogen peroxide in cells, leading to cell submicrostructure degeneration and cell necrosis. Candida albicans can inhibit its spores from turning into invasive hyphae.

Clotrimazole indications

This product is suitable for the treatment of skin candidiasis caused by Candida albicans;
Clotrimazole
Tinea, tinea corporis and tinea corporis caused by fungi, Trichophyton trichophyton, Trichophyton floccus and Microsporum canis, and Tinea versicolor caused by Malassezia furfur, can also be used to treat paronychia, Ringworm and tinea capitis.

Clotrimazole adverse reactions

Rash, congestion, swelling, blistering, scaling, skin burning, itching, or other signs of skin irritation can occur after topical application to the skin. Occurs in a small number of patients using vaginal suppositories
allergy
Local burning sensation, frequent urination, lower abdominal pain and other irritating symptoms, the above adverse reactions are generally rare and mild. Oral disorders may include insanity or confusion, disorientation, hallucinations, lethargy, depression. Can cause gastrointestinal reactions: nausea, vomiting, loss of appetite, bloating, diarrhea, diarrhea, rash, can cause liver damage, temporary elevated serum transaminase, hematuria, proteinuria, mild or temporary agranulocytopenia, leukopenia
nervous system
Common central nervous system reactions such as fatigue, sleepiness, depression, and severe mental disorders can occur.
Digestive system
Common loss of appetite, nausea, vomiting, epigastric pain, and diarrhea can reach 20%, and some reports have a higher incidence. Most patients may have elevated serum alkaline phosphatase and aminotransferase.
Urinary system
Frequent urination, some patients have a burning urethra when urinating. Proteinuria and hematuria have been reported without severe renal damage.
immune system
The literature mentions neutropenia but no more severe lesions.
Endocrinology, metabolism
This product can significantly increase the concentration of cortisol in the plasma, nausea or vomiting (16 cases), diarrhea (14 cases), and loss of appetite (10 cases).
Allergic reaction
Pimples, hives and contact allergic dermatitis appear.
other
Topical application is well tolerated, with less than 1% of allergic dermatitis or agitation.

Clotrimazole dosage

1. Apply a skin infection to the affected area 2-3 times a day.
2. Vaginitis Vaginal medication, once a night for 7 consecutive days.
1) Animal experiments have not found carcinogenesis and sperm chromosome mutagenesis.
2) Vaginal administration at the end of 3 months of pregnancy, no adverse effects on the fetus were found. However, in the study of mice and rats, the product was orally administered at a weight of 50 to 120 mg / kg, and the product was embryotoxic, but no distortion was found.
3) Breastfeeding women can be secreted into breast milk for external use, but no adverse reactions have been seen.
4) No special medication was found in children and elderly patients.
5) Avoid contact with eyes.
6) Topical application of this product can cause local skin irritation. If continued use can cause allergic reactions. Symptoms such as itching can usually be alleviated within 1 week after medication.
7) When using this product to treat skin candidiasis, avoid pressing the dressing tightly on the medicine or encapsulating it to prevent the growth of yeast and release of endotoxin. Vaginal administration. 1 tablet before bedtime, 1 tablet is a course of treatment. Place the tablet deep in the vagina with or without a dispenser. Generally, it can be used once, and if necessary, a second treatment can be performed after 4 days.
Clotrimazole
3 Apply a skin infection to the affected area 2 to 3 times a day.
4 Vaginitis Vaginal medication, 0.15g once, once per night for 7 consecutive days. Those who are allergic to any component of this product are prohibited.
5. Avoid contact with eyes.
6. Topical application of this product can cause local skin irritation and should be discontinued once it occurs.
7. When using this product to treat skin candidiasis, avoid pressing the dressing tightly on the medicine or packaging to avoid yeast growth.

Clotrimazole precautions

1. Animal experiments have not found that clotrimazole has carcinogenic and sperm chromosome aberrations in this product.
Clotrimazole
Changing effect.
2. Avoid contact with eyes.
3. The product can cause local skin irritation, and should be discontinued immediately if it occurs.
4. When using this product to treat skin candidiasis, avoid pressing the dressing tightly on the medicine or encapsulating it to avoid yeast growth.
5. Those who are allergic to this product or other imidazole drugs are contraindicated.
6, pregnant women, lactating women and women under 18 should consult a physician before using this product.
7. It is recommended to avoid treatment during menstruation.
8. Pay attention to personal hygiene during medication to prevent repeated infections.
9, this product is only for vaginal treatment, do not take orally.
10. Disable when the character of the product changes.
11. Seek medical attention immediately if overdose or serious adverse reactions occur.
12. Please keep this medicine out of the reach of children.
Medication for pregnant and lactating women
1. Clotrimazole was administered vaginal 3 months after the end of pregnancy, and no adverse effects were found on the fetus. But in mouse and rat studies, press
Clotrimazole
Oral clotrimazole weighing 50 to 120 mg / kg showed embryo toxicity but no teratogenic effects were found. Therefore, pregnant women should be used with caution.
2. If the product is used externally by lactating women, clotrimazole can be secreted into milk, so breastfeeding women should suspend breastfeeding when using this product.
Medication for children
Pediatric topical use of this product found no particularity.
Medication for elderly patients
Elderly patients found no particularity when using this product topically.

Clotrimazole burn treatment

Children with large-scale burns (scalds) are prone to fungal infections and spread throughout the body in the middle and late stages of treatment. The occurrence of fungal infections complicates the condition, which brings great difficulties to treatment and increases the mortality rate. At present, domestic and foreign literatures report that the treatment methods for fungal infections of burn wounds often use nano-silver yarn, polyvinylpyrrolidone-iodine (PVP-I) disinfectant, and local application of clotrimazole in wounds is rarely reported. From 1994 to 2004
Clotrimazole
Nineteen children with large area burns and severe fungal infections were treated. During the treatment of 10 children in the treatment group, we used clotrimazole ointment as an external application, and received good results. The treatment effect was successful in 10 cases. In contrast, 9 patients in the control group were treated with traditional methods, 5 with external iodine and bandaging wounds, 4 with exposure therapy, and only 3 survived. The purpose of this article is to evaluate and analyze the clinical efficacy of the 19 cases, aiming to improve the cure rate of children with large area burns and wound fungal infections and reduce the overall treatment costs.

Clotrimazole Information and Methods

Dexamethasone 1.1 General information: The 10 patients collected in the treatment group were children with fever (scald) with severe wound fungal infection in the last 10 years (1994-2004), including 6 males and 4 females. Example; aged 6 months to 4 years. The burned area ranged from 35% to 58%, with an average of 45%. The wounds were mainly deep degrees. Nine cases were hot water burns, and one case was flame burn. The wounds were mainly distributed on the trunk, hips, perineum and limbs.
Clotrimazole
The control group consisted of 9 children, 5 males and 4 females, aged from 3 months to 6 years old. The burn area was 28 to 53%, with an average of 39%. The wounds were mainly deep degrees, all of which were hot. Water burns, wounds are distributed on the trunk, perineum, and limbs.
1.2 treatment: 19 patients with admission were accompanied by varying degrees of shock symptoms. After admission, intravenous fluids were given to correct shock. All patients received large doses of broad-spectrum antibiotics intravenously at an early stage for two weeks, during which dexamethasone was used irregularly to reduce high fever. Wounds were treated with bandaging, semi-exposure or exposure therapy, and chloramphenicol oil gauze bandaging was routinely used. Due to the use of a large number of broad-spectrum antibiotics and irregular use of hormones, and the wounds were compressed and wet, the wounded areas such as the back and buttocks of the children were noticeably deepened, the color became darker, and scattered white plaques and insect bites were observed in the second week after injury The dent-like depression rapidly expanded, and in some cases oral leukoplakia appeared. After deep vein intubation was removed, the tube tips and back draw fluid were cultured, 13 of them had Candida and 6 were negative. Candida was found in wound culture.
In all the above cases, after the deep wounds and systemic fungal infections occurred, our department immediately stopped using all intravenous and local antibiotics. When the child was feverish, physical cooling was the main method. The use of hormones was avoided. The child was placed in a pediatric herringbone bed. Turn over and reduce pressure on the wound. At the same time, nutritional support treatment is enhanced with plasma. Oral antifungal drugs such as clotrimazole, fluconazole or ketoconazole are given at regular doses. In the treatment of local wounds, both the treatment group and the control group were actively debrided, and the separated crusts were actively cut to remove the mildew points as much as possible. The treatment group was mixed with clotrimazole ointment and paraffin oil gauze (15 grams of clotrimazole ointment and paraffin oil small gauze, the maximum dosage was 90 g of clotrimazole ointment), covering the wound with a single layer and changing the dressing once a day. In the control group, 5 cases were treated with external iodine and bandaging the wound, and 4 cases were exposed.

Clotrimazole results

After 10 days of continuous dressing change with clotrimazole ointment in the group of 10 children, 9 cases of wound culture had no fungal growth. The wound was clean and the granulation tissue was fresh. Autogenous skin grafting was performed 2 weeks later, and the wound healed. Another child with a burn area of 58% had deep wounds, extensive white plaques, and poor physical nutrition. After 10 days of dressing, there was still fungal growth in the wound culture, and the wounds were granulated, dry and flat.
Clotrimazole
Frank. After discussion, our department then attempted a forced operation to remove the fungal wounds on the back and buttocks of the child, and then covered the autologous skin. No postoperative dressing with clotrimazole ointment was performed. Immediately after that, the wound mold continued to grow rapidly and the skin graft failed. Thereafter, the patient was bandaged with clotrimazole ointment for 10 days. After the wound surface was cultured without fungal growth, the skin graft was performed again, and the wound was healed and discharged. Of the 9 cases in the control group, 5 cases were treated with compound iodine and the wound was bandaged. 3 cases survived and 2 cases died. Four patients died of exposure therapy (P <0.05).

Clotrimazole discussions

The rate of burns (scalds) with fungal infections has gradually increased for a number of reasons. Immunity of children's body drops sharply after burns; long-term, large-dose use of broad-spectrum antibiotics; deep vein intubation and placement time is too long; long-term irregular application of corticosteroids; coupled with wound pressure, humidity, and hot and humid in Guangdong Climate and other factors are all causes of wound fungal infections. The emergence of severe fungal infections on the wounds has brought great difficulties to treatment. Wounds will not heal for a long time, which can easily cause fungal septicemia and increase the mortality of children. Clotrimazole ointment is a broad-spectrum antifungal drug. It has high permeability to superficial fungal infections, strong antibacterial power, and has no irritation or trauma to burn wounds. It is suitable for the treatment of fungal infections on the superficial part of the body, and has a low price and a wide range of applications. It can effectively reduce the overall treatment cost of large-scale burns in children, and achieve the purpose of high efficacy and low cost. Efficacy of clotrimazole ointment on fungal infections in burn wounds has rarely been reported in previous literature. Through the analysis of the efficacy of the treatment group and control group cases, we concluded the following points.
3.1 The antibiotics should be used reasonably during the treatment of burns. 19 patients had used a large number of antibiotics throughout the body at an early stage, and the time was as long as 8 to 10 days. Each patient used at least two antibiotics. A maximum of one child had used a total of eight antibiotics, and all children had early wounds. Chloramphenicol was applied topically. Although at the same time
Clotrimazole
Ketoconazole was administered orally, but it did not prevent fungal infections. The early application of large doses of broad-spectrum antibiotics and the combined use of multiple antibiotics will undoubtedly help to control the bacterial invasion of wounds, but it is counterproductive to the control of fungal infections. Due to the long-term use of multiple antibiotics, it is easy to pass the action mechanism of bacterial flora alternation, which creates conditions for dominant fungal reproduction and bloodstream dissemination, and promotes the occurrence of secondary fungal infections. After the Candida infection occurred in the treatment group, when all antibiotics were discontinued, only oral antifungal drugs such as clotrimazole, fluconazole or ketoconazole were given, and clotrimazole ointment was applied to the wound. While under control, no other bacterial infections occurred during this period.
3.2 Corticosteroids should be used with caution in the treatment of burn patients. Burn patients were complicated by different degrees of infection, which led to different degrees of fever. In particular, the two groups of cases in this article are infants and young children. Because the central temperature of infants and young children is not fully developed, fever is more likely to occur during the treatment of burns. The children in the two groups had fever almost every day, especially after the dressing changes, and their body temperature was as high as 39 . In our department, dexamethasone is given 2 to 5 mg each time to lower the body temperature, causing most children to use hormones irregularly for more than 10 days. The side effects of corticosteroids can cause a decline in immune function, which is also an important factor causing secondary fungal infections. Therefore, the use of hormones in burn treatment must be strictly controlled, and it is not advisable to use hormones for a long time simply to reduce body temperature.
3.3 Special attention should be paid to fungal infections in the treatment of large-scale burns in children. After a large area of burn (burn) in children, due to the sharp decline in the body's immune function, the body's nutritional status has plummeted, coupled with extensive wound exposure, and irregular use of drugs, it is easier to cause wound fungal infections and systemic injuries than adults Spread. All cases in the two groups in this case showed signs of wound fungal infection around the 10th day after injury, and then spread to the whole body, causing fungal sepsis, which complicated the condition. It has brought great difficulties to treatment, and the mortality rate has increased significantly. This problem should cause great attention and vigilance by clinicians.
3.4 The application of clotrimazole in the treatment of severe fungal infections on wounds is a definite treatment, simple operation and low price. Fungal infections are one of the common complications after severe burns. Ten children in the treatment group were treated successfully with clotrimazole ointment for wound fungal infection. It can be seen that clotrimazole ointment has a strong penetrating effect, and topical application has a killing effect on the deep and shallow fungi of the wound.

Clotrimazole corneal ulcer treatment

Fungal corneal ulcer

Clotrimazole General Information

There were 7 eyes and 7 eyes in this group, 2 males and 5 females, aged 31 to 63 years. Have a history of corneal trauma and
Candida
History of treatment with antibiotics, 3 of which had a history of topical application of hormones. Patients have the symptoms and signs of typical fungal corneal ulcers, and long-term antibiotic treatment is not effective. The scrape was found for mycelia, and 5 cases were positive.

Clotrimazole method

0.2% fluconazole solution was applied to the eyes once an hour, while clotrimazole 500 mg was administered orally three times a day. The lesion was scraped and cauterized once a week with 2% iodine tincture. Conventional 1% atropine dilated pupils, oral multivitamins, corneal eye drops twice daily.

Clotrimazole results

All 7 patients in this group were cured, the ulcer healed, and the fluorescein staining was negative. The course of treatment was 14 to 35 days, with an average of 19 days.

Clotrimazole discussions

Common pathogenic strains of fungal corneal ulcers are Aspergillus, Fusarium and Candida albicans. Its main action principle is to inhibit the activation of cytochrome P-450 and enzyme functions, leading to dysfunction of ergosterol synthesis, thereby damaging the function and structure of fungal cells. High-concentration drugs can inhibit membrane phospholipid synthesis and damage fungal cell membranes. In addition, it can also inhibit the peroxidase of cytochrome oxidase, causing a large accumulation of peroxide in the bacteria and causing fungal death. Clotrimazole is an oral broad-spectrum antifungal drug, which can inhibit the lipid synthesis of the cell membrane, change the permeability of the membrane, and cause a large amount of cytoplasmic components to be lost in the bacteria. The combination of fluconazole and clotrimazole not only exerts the characteristics of fluconazole's good intraocular permeability, convenient local application, quick response, short course of treatment, and few side effects, but also uses the broad-spectrum antifungal properties of clotrimazole Characteristics, and thus received a relatively satisfactory treatment effect [4] .

Clotrimazole suppositories

[Ingredients] Each of this product contains 0.15 grams of the main ingredient clotrimazole.
[Character] This product is milky white or light yellow round cone suppository.
[Category of Action] This product is a non-prescription drug for gynecological use.
[Pharmacology and Toxicology] This strain is a broad-spectrum antifungal drug, which has antibacterial effect on a variety of fungi, especially Candida albicans. Its mechanism of action is to inhibit the synthesis of fungal cell membranes and affect its metabolic processes.
Pharmacokinetics
[Indications] Candida vulvovaginitis.
[Usage and dosage] Vaginal administration. After washing, place the suppository deep in the vagina. Once a night, once a capsule. 7 consecutive days is a course of treatment.
[Adverse reactions] Occasionally allergic reactions.
[Taboo]
[Precautions] Disable those who are allergic to this product. Disabled during the first 3 months of pregnancy. Avoid contact with eyes and avoid oral administration. It is forbidden to use this product when its properties change. Keep this product out of the reach of children.
[Medication for pregnant and lactating women]
[Child medication]
[Medication for elderly patients]
[Drug interaction] If you are using other medicines, please consult your doctor or pharmacist before using this product.
[Drug overdose]
specification
[Storage] Sealed and stored below 30 ° C.
package
[Validity] 24 months [5]

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