Level I, prospective randomized trial.

to carry out an audit study of their department, of which this study is a part; and the doctors, secretaries, and patients whose cooperation made this study possible.

No abstract

The cover image is based on the Behavioural Notes Dodging sexual conflict?—Sub‐adult females of a web‐building spider stay cryptic to mate‐seeking adult males, by Andreas Fischer et al. DOI: .

Antifungal chemotherapySuperficial fungal infections caused by dermatophytes and yeasts are among the commonest cutaneous diseases. Fortunately, in the United Kingdom systemic fungal infections are rare, although their incidence in recent years has been increased by opportunistic infection in immunosuppressed patients. Despite this increase in systemic infections the development of effective antifungal drugs has lagged well behind that of antibiotics, at least in part because fewer differences in cell type exist between the eukaryotic fungal pathogen and host than between the prokaryotic bacterial pathogen and host. Until 1970 there were a few antifungal drugs, which had certain limitations including toxicity, narrow spectrum of activity, parenteral administration, and commonly a failure to cure. With the advent of the imidazole derivatives a major new class of antifungal drugs has emerged which combines low toxicity and versatility of administration with a wide spectrum of antifungal action against dermatophytes, yeasts, and dimorphic fungi. IMIDAZOLESThe precise mechanism of action of the imidazoles is not known but one important effect may be the inhibition of the synthesis of ergosterol. This is an essential component of fungal plasma membranes which is not required by mammals. Additionally, imidazoles inhibit the transformation of candidal yeast to hyphal forms which renders the organism more susceptible to phagocytosis by host leucocytes. These diverse effects may explain the broad spectrum of the imidazoles and the rarity of drug resistant strains.Although lesions. Isoconazole (Travogyn) is given as a single dose vaginal tablet. Systemic absorption of these drugs from the skin or from the vagina is minimal. Side effects are uncommon (1-4%) consisting of minor irritation, burning, or itching at the site of application. Intravenous administrationIntravenous administration of miconazole (Daktarin) produces therapeutic drug concentrations in bone, joint, lung, and oesophageal tissue. Intrathecal administration is necessary for meningeal and cerebral infections. The drug is rapidly metabolised in the liver and its excretion is unaffected by renal insufficiency. Side effects are uncommon; intestinal disturbance is the most frequent while pruritus, rash, fever, anaemia, and thrombocytosis occur rarely. Miconazole enhances the anticoagulant effect of warfarin.