Complications
Table 5. Treatment Options
Agent
(Brand)
Flucytosine
Ancobon®
FDA Approved Dose*
Azoles
Fluconazole
Diflucan®
Itraconazole
Sporanox®
Posaconazole
Noxafil ®
Voriconazole
Vfend ®
Amphotericins
AmB
Fungizone®
Comments
PO – 50-150 mg/kg per day Use with extreme caution with renal impairment or
in divided doses at 6-hour bone marrow depression.
intervals
PO, IV – 400 mg
(12 mg/kg) on day 1,
then 200-400 mg
(6-12 mg/kg)
daily x 10-12 wks
IV or PO
Reduce dose with renal impairment.
PO (oral suspension)
IV or PO – 400 mg
(6 mg/kg) bid x 2 doses, then
200 mg (3 mg/kg) bid
Slow IV infusion –
0.25-0.3 mg/kg per day
Max: 1.5 mg/kg per day
AmBd generic
IV – 0.3-1 mg/kg per day
Liposomal AmB
AmBisome®
IV – 3-6 mg/kg per day
orally in 4 divided doses
Warning: This drug should be used primarily
for treatment of patients with progressive and
potentially life-threatening fungal infections.
Acute reactions including fever, shaking chills,
hypotension, anorexia, nausea, vomiting,
headache, and tachypnea are common 1 to 3 hours
after starting an intravenous infusion.
ABLC
Abelcet®
IV – 5 mg/kg per day
120 min IV infusion
Indicated for patients who are refractory to or
intolerant of conventional AmB.
*See PI for details
Abbreviations
ABLC, amphotericin B lipid complex; AmB, amphotericin B; AmBd, amphotericin B deoxycholate; CNS,
central nervous system; CSF, cerebrospinal fluid; HAART, highly active antiretroviral therapy; HIV, human
immunodeficiency virus; IFN, interferon; IRIS, immune reconstitution inflammatory syndrome; LFAmB,
lipid formulations of AmB; MIC, Minimum Inhibitory Concentration; VP, ventriculoperitoneal
Source
Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA,
Lortholary O, Nguyen MH, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC. Clinical practice
guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of
America. Clin Infect Dis. 2010 Feb 1;50(3):291-322.
Disclaimer
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