Complications
Table 5. Treatment Options Agent
FDA Approved Dose*
Flucytosine Ancobon®
Azoles
Fluconazole Diflucan®
Itraconazole Sporanox®
Posaconazole Noxafil®
Voriconazole Vfend®
Amphotericins
AmB Fungizone®
Slow IV infusion – 0.25-0.3 mg/kg per day Max: 1.5 mg/kg per day
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 aſter starting an intravenous infusion.
AmBd generic
Liposomal AmB AmBisome®
ABLC Abelcet®
*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 This Guideline attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.
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IV – 0.3-1 mg/kg per day
IV – 3-6 mg/kg per day orally in 4 divided doses
IV – 5 mg/kg per day 120 min IV infusion
Indicated for patients who are refractory to or intolerant of conventional AmB.
(12 mg/kg) on day 1, then 200-400 mg (6-12 mg/kg)
daily x 10-12 wks IV or PO
(6 mg/kg) bid x 2 doses, then 200 mg (3 mg/kg) bid
PO (oral suspension) IV or PO – 400 mg
PO, IV – 400 mg Reduce dose with renal impairment.
PO – 50-150 mg/kg per day in divided doses at 6-hour intervals
Comments
Use with extreme caution with renal impairment or bone marrow depression.
(Br
and)
