Template:ID-Fungal meningitis: Difference between revisions

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::* 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
::* 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]] {{withorwithout}} 3—5 mg/kg/day IV [[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 for 2 doses, followed by 200 mg PO bid {{or}} [[Voriconazole]] 6 mg/kg IV q12h for 2 doses, followed by 3 mg/kg IV q12h


:* '''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]





Revision as of 00:22, 20 June 2015

  • Fungal meningitis
  • Blastomyces dermatitidis[1]
  • Candida spp.



  • 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]

  1. Chapman, Stanley W.; Dismukes, William E.; Proia, Laurie A.; Bradsher, Robert W.; Pappas, Peter G.; Threlkeld, Michael G.; Kauffman, Carol A.; Infectious Diseases Society of America (2008-06-15). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 46 (12): 1801–1812. doi:10.1086/588300. ISSN 1537-6591. PMID 18462107.