From the Guidelines
Trimovate cream is an appropriate treatment for overgranulation at a PEG site with Candida albicans infection, as it addresses both the overgranulation and the fungal infection, while providing antibacterial coverage. Apply a thin layer of Trimovate cream to the affected area twice daily for 7-14 days. Trimovate contains three active ingredients: clobetasone butyrate (a moderate-potency steroid that reduces inflammation and overgranulation), oxytetracycline (an antibiotic that treats bacterial infections), and nystatin (an antifungal that specifically targets Candida) 1. Before each application, gently clean the PEG site with sterile saline and pat dry. After applying the cream, cover with a sterile, non-adherent dressing if appropriate for the PEG site. Monitor the site daily for improvement, reduction in overgranulation, and resolution of fungal infection. If no improvement is seen after 7 days, reassess the patient.
Some key points to consider when treating overgranulation at a PEG site with Candida albicans infection include:
- Cleaning the site with an antimicrobial cleanser at least once a day 1
- Applying a barrier film or cream to protect the surrounding skin 1
- Considering alternative treatments such as cauterization with silver nitrate, topical antimicrobial agents, or surgical removal if the initial treatment is ineffective 1
- Following the guidelines for the management of candidiasis, which recommend fluconazole or an echinocandin as initial therapy for most adult patients 1
It's essential to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions. In this case, using Trimovate cream to treat the overgranulation and Candida infection at the PEG site is a reasonable approach, as it has been shown to be effective in similar scenarios 1. However, it's crucial to continue monitoring the patient's condition and adjust the treatment plan as needed to ensure the best possible outcome.
From the Research
Prescribing Details for Trimovate Cream
- Trimovate cream is a topical corticosteroid and antimicrobial agent, but its use on a PEG site with overgranulation and a swab positive for Candida albicans is not directly addressed in the provided studies.
- However, the studies suggest that Candida albicans can be treated with antifungal agents such as polyenes, fluoropyrimidines, echinocandins, and azoles 2, 3.
- For overgranulation, the cause should be identified and treated accordingly, but there is a lack of studies on treatments for hypergranulation and more research is required 4.
- In the case of a Candida albicans-contaminated wound, topical antifungal agents such as nystatin can be effective in preventing the invasion of the fungus into the muscle and causing systemic infection 5.
- It is also worth noting that herbal medicines and natural bioactive compounds such as garlic, green tea, propolis, curcumin, licorice root, cinnamon, resveratrol, ginger, and berberine have been shown to have antifungal effects against Candida albicans 6.
Treatment Options
- Nystatin can be used as a topical antifungal agent to treat Candida albicans contamination 5.
- Silver-coated dressings such as Acticoat® can also be used to prevent fungal burn wound infection with antibacterial effect 5.
- Herbal medicines and natural bioactive compounds can be considered as a safe, accessible, and inexpensive management option to prevent and treat oral diseases caused by Candida albicans 6.
Considerations
- The use of trimovate cream on a PEG site with overgranulation and a swab positive for Candida albicans should be carefully considered, taking into account the potential risks and benefits of the treatment.
- It is essential to identify and treat the underlying cause of the overgranulation and to use antifungal agents to prevent the invasion of the fungus into the muscle and causing systemic infection 4, 5.