From the Guidelines
The treatment for Malassezia infection involves discontinuation of intralipids and removal of the intravascular catheter, especially with nontunneled catheter infections, and should be treated with amphotericin B.
Key Considerations
- The evidence from 1 suggests that treatment of catheter-related Malassezia furfur fungemia should include removal of the catheter and discontinuation of intralipids.
- Amphotericin B is recommended for the treatment of Malassezia furfur fungemia, as stated in 1.
Treatment Approach
- Discontinuation of intralipids is necessary to prevent further infection.
- Removal of the intravascular catheter, especially with nontunneled catheter infections, is crucial to prevent the spread of infection.
- Amphotericin B should be used as the primary antifungal medication for treating Malassezia furfur fungemia.
Important Notes
- The treatment approach should prioritize the removal of the catheter and discontinuation of intralipids, followed by antifungal therapy with amphotericin B.
- The evidence from 1 provides a clear guideline for the treatment of Malassezia furfur fungemia, and this approach should be followed to ensure the best possible outcome.
From the FDA Drug Label
Ketoconazole Cream 2% is indicated for the topical treatment of ... in the treatment of tinea (pityriasis) versicolor caused by Malassezia furfur (Pityrosporum orbiculare); Microbiology: Ketoconazole is a broad spectrum synthetic antifungal agent which inhibits the in vitro growth of the following common dermatophytes and yeasts ... yeasts: ... Malassezia ovale (Pityrosporum ovale) and ... Malassezia furfur (Pityrosporum orbiculare).
The treatment for Malassezia (fungus) infection is topical ketoconazole.
- The indicated use of ketoconazole cream 2% includes the treatment of tinea versicolor caused by Malassezia furfur 2.
- Ketoconazole has been shown to inhibit the growth of Malassezia species, including M. furfur and M. ovale 3.
From the Research
Treatment Options for Malassezia Infection
The treatment for Malassezia infection, also known as pityriasis versicolor, includes various antifungal agents. Some of the most effective treatments are:
- Ketoconazole, which possesses the strongest in vitro activity against Malassezia 4
- Itraconazole, which is the drug of choice for oral treatment of pityriasis versicolor 4
- Fluconazole, which is an effective alternative to itraconazole 4
- Terbinafine, an allylamine antifungal agent 4
- Ciclopirox olamine, a hydroxypyridone antifungal agent 4
- "Antiseborrhoeic" agents, such as zinc pyrithione, selenium disulfide, and salicylic acid, which are also effective in treating pityriasis versicolor 4
Topical and Oral Treatments
Topical treatments, such as ketoconazole and sertaconazole, are effective in treating seborrhoeic dermatitis, a Malassezia-associated inflammatory dermatosis 4. Oral treatments, such as itraconazole and fluconazole, are used for extensive disease, frequent relapse, or where topical agents have failed 5.
Efficacy of Single Dose and Daily Dose Itraconazole
A study compared the efficacy of single dose (400 mg) and 7 day (200 mg) daily dose itraconazole in the treatment of tinea versicolor, and found that both regimens were effective, but single dose appeared to be better for improving compliance and decreasing the cost of treatment 5.
Antifungal Activity of Ketoconazole
Ketoconazole has been shown to have good antifungal activity against Malassezia furfur in vitro and in vivo, and its levels can accumulate in the beard and reach therapeutic levels, making it a useful treatment for eradication of M. furfur in patients with pityriasis versicolor 6.
Prevention of Recurrence
A study found that preventive treatment with itraconazole after a short course of itraconazole therapy can help prevent the recurrence of tinea versicolor, with clinical improvement, negative Wood's lamp examination, and mycological cure found in 90%, 84.4%, and 83.3% of patients, respectively, after 6 months of preventive treatment 7.