Template:ID-Fungal meningitis

• Fungal meningitis

• Blastomyces dermatitidis

• Preferred regimen: Liposomal Amphotericin B 5 mg/kg/day IV for 4—6 weeks, followed by Fluconazole 800 mg PO qd OR Itraconazole 200 mg PO bid—tid OR Voriconazole 200—400 mg PO bid for ≥12 months until CSF abnl resolves

• Candida spp.

Preferred Regimen ▸ Liposomal Amphotericin B 3—5 mg/kg/day IV WITH OR WITHOUT ▸ Flucytosine 25 mg/kg PO qid Alternative Regimen ▸ Fluconazole 400—800 mg PO qd (6—12 mg/kg IV q24h) OR ▸ Voriconazole 400 mg PO bid × 2 doses FOLLOWED BY 200 mg PO bid OR ▸ Voriconazole 6 mg/kg IV q12h × 2 doses FOLLOWED BY 3 mg/kg IV q12h Adapted from Clin Infect Dis. 2009;48(5):503-35.[8]

• Coccidioides immitis

Preferred Regimen ▸ Fluconazole 400 mg PO qd Alternative Regimen ▸ Itraconazole 200 mg PO bid—tid Adapted from Clin Infect Dis. 2005;41(9):1217-23.[9]

• C. neoformans, HIV–infected

Induction Therapy: Preferred Regimen 1 ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for ≥2 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for ≥2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks PLUS ▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks Induction Therapy: Preferred Regimen 2 ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for 4—6 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for 4—6 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4—6 weeks Induction Therapy: Alternative Regimen 1 ▸ Amphotericin B 0.7 mg/kg IV q24h for 2 weeks PLUS ▸ Fluconazole 800 mg PO q24h for 2 weeks Induction Therapy: Alternative Regimen 2 ▸ Fluconazole 1200 mg PO q24h for 6 weeks PLUS ▸ Flucytosine 100 mg/kg PO q24h for 6 weeks Induction Therapy: Alternative Regimen 3 ▸ Fluconazole 800—2000 mg PO q24h for 10—12 weeks Induction Therapy: Alternative Regimen 4 ▸ Itraconazole 200 mg PO q12h for 10—12 weeks Consolidation Therapy ▸ Fluconazole 400 mg PO q24h for 8 weeks Maintenance Therapy ▸ Fluconazole 200 mg PO q24h for ≥1 year OR ▸ Itraconazole 400 mg PO q24h for ≥1 year OR ▸ Amphotericin B 1.0 mg/kg/week IV for ≥1 year

• C. neoformans, Organ Transplant Recipients

Induction Therapy: Preferred Regimen ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for ≥2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks PLUS ▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks Induction Therapy: Alternative Regimen ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for 4—6 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4—6 weeks Consolidation Therapy ▸ Fluconazole 400—800 mg PO q24h for 8 weeks Maintenance Therapy ▸ Fluconazole 200—400 mg PO q24h for 6—12 months

• C. neoformans, Non–HIV-Infected and Nontransplant Hosts

Induction Therapy: Preferred Regimen ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for 4—6 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for 4—6 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4—6 weeks PLUS ▸ Flucytosine 25 mg/kg PO q6h for 4—6 weeks Consolidation Therapy ▸ Fluconazole 400—800 mg PO q24h for 8 weeks Maintenance Therapy ▸ Fluconazole 200 mg PO q24h for 6—12 months Adapted from Clin Infect Dis. 2010;50(3):291-322.[10]

• Histoplasma capsulatum

Preferred Regimen ▸ Liposomal Amphotericin B 5 mg/kg IV q24h for 4—6 weeks FOLLOWED BY ▸ Itraconazole 200 mg PO bid—tid for ≥12 months Adapted from Clin Infect Dis. 2007;45(7):807-25.[11]