Blastomycosis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Blastomycosis}} | {{Blastomycosis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{VB}}{{ADG}} | ||
==Overview== | ==Overview== | ||
As per the guidelines given by the Infectious Diseases Society of America the appropriate regimen must be guided by the clinical form and severity of disease, as well as the [[Immune system|immune status]] of patient and toxicity of [[Antifungal agent|antifungal agents]]. Only [[asymptomatic]] [[infections]] are left untreated, otherwise all cases need therapy. | |||
*[[Immunocompetent]] patient. (Non-Life threatening infection): Drug of choice in this cases is usually [[Itraconazole]] or [[Amphotericin B|Lipid Amphotericin B]]. Alternatively, daily [[fluconazole]] or w may also be used. | |||
* | *[[Immunocompetent]] patient. (Life threatening infection) | ||
* | **[[Pulmonary]] cases - These warrant treatment primarily with [[Amphotericin B|Lipid Amphotericin B]] or [[Amphotericin B|Deoxycholate Amphotericin B]]. Once the condition has been stabilized the patient may be switched to oral [[Itraconazole]] therapy. | ||
**[[Disseminated disease|Disseminated]] cases - Drug of choice is same, however patients non tolerant to [[Amphotericin B]] can be treated with [[fluconazole]] or [[Itraconazole]]. | |||
* | * [[Immunocompromised]] patients: All patients warrant treatment with [[Amphotericin B|Lipid Amphotericin B]] as the drug of choice and [[Itraconazole]] once the disease has shown clinical improvement. | ||
==Medical Therapy== | |||
===Antimicrobial Regimen=== | ===Antimicrobial Regimen=== | ||
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:*'''Mild to moderate pulmonary blastomycosis'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | :*'''Mild to moderate pulmonary blastomycosis'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | ||
::*Preferred regimen: [[Itraconazole]] 200 mg PO | ::*Preferred regimen: [[Itraconazole]] 200 mg PO q12-24h for 6–12 months | ||
::*Note: | ::*Note:Initially oral [[Itraconazole]], 200 mg for 3 days and then q12-24h for 6–12 months, is recommended | ||
:*'''Moderately severe to severe pulmonary blastomycosis'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | :*'''Moderately severe to severe pulmonary blastomycosis'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | ||
::*Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg | ::*Preferred regimen(1): [[Amphotericin B|Lipid amphotericin B]] (Lipid AmB) 3–5 mg/kg IV q 24h for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO q 12h for 6–12 months | ||
::*Preferred regimen(2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg | ::*Preferred regimen(2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg IV q 24h for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO q 12h for 6–12 months | ||
::*Note: Oral [[Itraconazole]], 200 mg | ::*Note: Oral [[Itraconazole]], 200 mg q8h for 3 days and then 200 mg q12h for 6–12 months, is recommended | ||
:*'''Mild to moderate disseminated blastomycosis'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | :*'''Mild to moderate disseminated blastomycosis'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | ||
::*Preferred regimen: [[Itraconazole]] 200 mg PO | ::*Preferred regimen: [[Itraconazole]] 200 mg PO q12-24h for 6–12 months | ||
::*Note(1): Treat osteoarticular disease for 12 months | ::*Note(1): Treat [[Osteoarticular pain|osteoarticular]] disease for 12 months | ||
::*Note(2): Oral [[Itraconazole]], 200 mg | ::*Note(2): Oral [[Itraconazole]], 200 mg q8h for 3 days and then 200 mg q12h for a total of 6–12 months, is recommended | ||
:*'''Moderately severe to severe disseminated blastomycosis'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | :*'''Moderately severe to severe disseminated blastomycosis'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | ||
::*Preferred regimen(1): Lipid amphotericin B(Lipid AmB) 3–5 mg/kg | ::*Preferred regimen(1): [[Amphotericin B|Lipid amphotericin B]](Lipid AmB) 3–5 mg/kg IV q24h for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO q12h for 6–12 months | ||
::*Preferred regimen(2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg | ::*Preferred regimen(2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg IV q24h for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO q12h for 6–12 months | ||
::*Note: oral [[Itraconazole]], 200 mg | ::*Note: oral [[Itraconazole]], 200 mg q8h for 3 days and then 200 mg q12h, for a total of 6–12 months, is recommended | ||
:*'''CNS disease'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | :*'''CNS disease'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | ||
::*Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg | ::*Preferred regimen: [[Amphotericin B|Lipid amphotericin B]] (Lipid AmB) IV 5 mg/kg q24h for 4–6 weeks {{and}} an oral [[azole]] for at least 1 year | ||
::*Note(1): Step-down therapy can be with [[Fluconazole]], 800 mg per day {{or}} [[Itraconazole]], 200 mg | ::*Note(1): Step-down therapy can be with [[Fluconazole]], 800 mg per day {{or}} [[Itraconazole]], 200 mg q8-12h per day {{or}} [[voriconazole]], 200–400 mg q12h | ||
::*Note(2): Longer treatment may be required for immunosuppressed patients. | ::*Note(2): Longer treatment may be required for [[immunosuppressed]] patients. | ||
:*'''Immunosuppressed patients'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | :*'''Immunosuppressed patients'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | ||
::*Preferred regimen(1): Lipid amphotericin B (Lipid AmB), 3–5 mg/kg | ::*Preferred regimen(1): [[Amphotericin B|Lipid amphotericin B]] (Lipid AmB), 3–5 mg/kg IV q24h for 1–2 weeks, {{and}} [[Itraconazole]], 200 mg PO q12h for 12 months | ||
::*Preferred regimen(2): [[Amphotericin B]] deoxycholate, 0.7–1 mg/kg | ::*Preferred regimen(2): [[Amphotericin B]] deoxycholate, 0.7–1 mg/kg IV q24h, for 1–2 weeks, {{and}} [[Itraconazole]], 200 mg POq12h for 12 months | ||
::*Note(1): Oral [[Itraconazole]], 200 mg | ::*Note(1): Oral [[Itraconazole]], 200 mg q8h for 3 days and then 200 mg q12h, for a total of 12 months, is recommended | ||
::*Note(2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed. | ::*Note(2): Life-long suppressive treatment may be required if [[immunosuppression]] cannot be reversed. | ||
:*'''Pregnant women'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | :*'''Pregnant women'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | ||
::*Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg | ::*Preferred regimen: [[Amphotericin B|Lipid amphotericin B]] (Lipid AmB) 3–5 mg/kg IV q24h | ||
::*Note(1): Azoles should be avoided because of possible teratogenicity | ::*Note(1): [[Azoles]] should be avoided because of possible [[teratogenicity]] | ||
::*Note(2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg | ::*Note(2): If the newborn shows evidence of [[infection]], treatment is recommended with [[Amphotericin B|Amphotericin B deoxycholate]], 1.0 mg/kg IV q24h | ||
:*'''Children with mild to moderate disease'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | :*'''Children with mild to moderate disease'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | ||
::*Preferred regimen: [[Itraconazole]] 10 mg/kg PO | ::*Preferred regimen: [[Itraconazole]] 10 mg/kg PO q24h for 6–12 months | ||
::*Note: Maximum dose 400 mg | ::*Note: Maximum dose 400 mg q24h | ||
:*'''Children with moderately severe to severe disease'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | :*'''Children with moderately severe to severe disease'''<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107 }} </ref> | ||
::*Preferred regimen(1): Amphotericin B deoxycholate 0.7–1 mg/kg | ::*Preferred regimen(1): [[Amphotericin B|Amphotericin B deoxycholate]] 0.7–1 mg/kg IV q24h for 1–2 weeks {{and}} [[Itraconazole]] 10 mg/kg PO q24h to a maximum of 400 mg q24h for 6–12 months | ||
::*Preferred regimen(2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg | ::*Preferred regimen(2): [[Amphotericin B|Lipid amphotericin B]] (Lipid AmB) 3–5 mg/kg IV q24h for 1–2 weeks {{and}} [[Itraconazole]] 10 mg/kg PO q24h to a maximum of 400 mg q24h for 6–12 months | ||
::*Note: Children tolerate Amphotericin B deoxycholate better than adults do. | ::*Note: Children tolerate [[Amphotericin B|Amphotericin B deoxycholate]] better than adults do. | ||
==References== | ==References== | ||
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Latest revision as of 20:37, 29 July 2020
Blastomycosis Microchapters |
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Blastomycosis medical therapy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidit Bhargava, M.B.B.S [2]Aditya Ganti M.B.B.S. [3]
Overview
As per the guidelines given by the Infectious Diseases Society of America the appropriate regimen must be guided by the clinical form and severity of disease, as well as the immune status of patient and toxicity of antifungal agents. Only asymptomatic infections are left untreated, otherwise all cases need therapy.
- Immunocompetent patient. (Non-Life threatening infection): Drug of choice in this cases is usually Itraconazole or Lipid Amphotericin B. Alternatively, daily fluconazole or w may also be used.
- Immunocompetent patient. (Life threatening infection)
- Pulmonary cases - These warrant treatment primarily with Lipid Amphotericin B or Deoxycholate Amphotericin B. Once the condition has been stabilized the patient may be switched to oral Itraconazole therapy.
- Disseminated cases - Drug of choice is same, however patients non tolerant to Amphotericin B can be treated with fluconazole or Itraconazole.
- Immunocompromised patients: All patients warrant treatment with Lipid Amphotericin B as the drug of choice and Itraconazole once the disease has shown clinical improvement.
Medical Therapy
Antimicrobial Regimen
- Blastomycosis
- Mild to moderate pulmonary blastomycosis[1]
- Preferred regimen: Itraconazole 200 mg PO q12-24h for 6–12 months
- Note:Initially oral Itraconazole, 200 mg for 3 days and then q12-24h for 6–12 months, is recommended
- Moderately severe to severe pulmonary blastomycosis[1]
- Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg IV q 24h for 1–2 weeks AND Itraconazole 200 mg PO q 12h for 6–12 months
- Preferred regimen(2): Amphotericin B deoxycholate 0.7–1 mg/kg IV q 24h for 1–2 weeks AND Itraconazole 200 mg PO q 12h for 6–12 months
- Note: Oral Itraconazole, 200 mg q8h for 3 days and then 200 mg q12h for 6–12 months, is recommended
- Mild to moderate disseminated blastomycosis[1]
- Preferred regimen: Itraconazole 200 mg PO q12-24h for 6–12 months
- Note(1): Treat osteoarticular disease for 12 months
- Note(2): Oral Itraconazole, 200 mg q8h for 3 days and then 200 mg q12h for a total of 6–12 months, is recommended
- Moderately severe to severe disseminated blastomycosis[1]
- Preferred regimen(1): Lipid amphotericin B(Lipid AmB) 3–5 mg/kg IV q24h for 1–2 weeks AND Itraconazole 200 mg PO q12h for 6–12 months
- Preferred regimen(2): Amphotericin B deoxycholate 0.7–1 mg/kg IV q24h for 1–2 weeks AND Itraconazole 200 mg PO q12h for 6–12 months
- Note: oral Itraconazole, 200 mg q8h for 3 days and then 200 mg q12h, for a total of 6–12 months, is recommended
- CNS disease[1]
- Preferred regimen: Lipid amphotericin B (Lipid AmB) IV 5 mg/kg q24h for 4–6 weeks AND an oral azole for at least 1 year
- Note(1): Step-down therapy can be with Fluconazole, 800 mg per day OR Itraconazole, 200 mg q8-12h per day OR voriconazole, 200–400 mg q12h
- Note(2): Longer treatment may be required for immunosuppressed patients.
- Immunosuppressed patients[1]
- Preferred regimen(1): Lipid amphotericin B (Lipid AmB), 3–5 mg/kg IV q24h for 1–2 weeks, AND Itraconazole, 200 mg PO q12h for 12 months
- Preferred regimen(2): Amphotericin B deoxycholate, 0.7–1 mg/kg IV q24h, for 1–2 weeks, AND Itraconazole, 200 mg POq12h for 12 months
- Note(1): Oral Itraconazole, 200 mg q8h for 3 days and then 200 mg q12h, for a total of 12 months, is recommended
- Note(2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.
- Pregnant women[1]
- Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg IV q24h
- Note(1): Azoles should be avoided because of possible teratogenicity
- Note(2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg IV q24h
- Children with mild to moderate disease[1]
- Preferred regimen: Itraconazole 10 mg/kg PO q24h for 6–12 months
- Note: Maximum dose 400 mg q24h
- Children with moderately severe to severe disease[1]
- Preferred regimen(1): Amphotericin B deoxycholate 0.7–1 mg/kg IV q24h for 1–2 weeks AND Itraconazole 10 mg/kg PO q24h to a maximum of 400 mg q24h for 6–12 months
- Preferred regimen(2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg IV q24h for 1–2 weeks AND Itraconazole 10 mg/kg PO q24h to a maximum of 400 mg q24h for 6–12 months
- Note: Children tolerate Amphotericin B deoxycholate better than adults do.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG; et al. (2008). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clin Infect Dis. 46 (12): 1801–12. doi:10.1086/588300. PMID 18462107.