Fungal Infections

Econazole

Econazole (Ecostatin, Ecoderm, Pevaryl and multiple other names) is a synthetic imidazole very similar in structure to miconazole. It was first synthesized in 1969, first used in patients in the 1970’s and licensed for use in 1974. Like other azoles, it inhibits the production of ergosterol, a key chemical in the cell walls of fungi, by interfering with the enzyme 14 alpha demethylase, but may have other cellular actions, based on studies in Candida albicans.

Dose & Delivery

Econazole 1% cream, lotion, powder or solution is only used topically usually 3 times daily for 2-4 weeks. Econazole is effective for seborrheic dermatitis, nappy rash due to Candida, some cases of ringworm, tinea cruris and athlete’s foot. A 1% solution can be used for otitis externa. For inflammatory conditions such as seborrheic dermatitis, combined preparations with topical corticosteroid are helpful.

For vaginal candidiasis, pessaries of 150mg are give daily for 3 nights. Alternatively 5g of a 1% vaginal cream can be given for 2 weeks each night. Econazole cream is also used to treat penile candidiasis (balanitis).

Fungi - the drug is active against.   

Econazole is active against most Candida species and skin fungi such as Trichophyton spp., Microsporum spp. and Epidermophyton floccosum and Malassezia spp., as well as some systemic fungal pathogens such as Aspergillus spp. It has some anti-bacterial activity as well. Some imidazole resistance is documented in Candida albicans and can be inferred from miconazole susceptibility results.

Metabolism distribution and excretion.                      

Systemic absorption of econazole is minimal and applied on the skin it penetrates only the surface layer (epidermis). Vaginal administration leads to minimal systemic absorption, but may be enough to initiate an attack of acute intermittent porphyria in those with this rare disease.

Drug/ Drug interactions                      

There are very few drug/drug interactions with econazole. Pessaries of econazole may damage latex condoms or diaphragms and so alternative contraceptive precautions are best used. View drug interactions database.

Side effects                 

Econazole may lead to local skin irritation and a burning sensation. Econazole may be given in pregnancy, although nystatin is preferred.

Structure of econazole

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