Template:ID-Fungal meningitis: Difference between revisions
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* Fungal meningitis | * Fungal meningitis | ||
:* '''Blastomyces dermatitidis'''<ref>{{Cite journal| doi = 10.1086/588300| issn = 1537-6591| volume = 46| issue = 12| pages = 1801–1812| last1 = Chapman| first1 = Stanley W.| last2 = Dismukes| first2 = William E.| last3 = Proia| first3 = Laurie A.| last4 = Bradsher| first4 = Robert W.| last5 = Pappas| first5 = Peter G.| last6 = Threlkeld| first6 = Michael G.| last7 = Kauffman| first7 = Carol A.| last8 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-06-15| pmid = 18462107}}</ref> | :* '''Blastomyces dermatitidis'''<ref>{{Cite journal| doi = 10.1086/588300| issn = 1537-6591| volume = 46| issue = 12| pages = 1801–1812| last1 = Chapman| first1 = Stanley W.| last2 = Dismukes| first2 = William E.| last3 = Proia| first3 = Laurie A.| last4 = Bradsher| first4 = Robert W.| last5 = Pappas| first5 = Peter G.| last6 = Threlkeld| first6 = Michael G.| last7 = Kauffman| first7 = Carol A.| last8 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-06-15| pmid = 18462107}}</ref> | ||
::* Preferred regimen: [[Liposomal Amphotericin B]] 5 mg/kg/day IV for | ::* 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.'''<ref>{{Cite journal| doi = 10.1086/596757| issn = 1537-6591| volume = 48| issue = 5| pages = 503–535| last1 = Pappas| first1 = Peter G.| last2 = Kauffman| first2 = Carol A.| last3 = Andes| first3 = David| last4 = Benjamin| first4 = Daniel K.| last5 = Calandra| first5 = Thierry F.| last6 = Edwards| first6 = John E.| last7 = Filler| first7 = Scott G.| last8 = Fisher| first8 = John F.| last9 = Kullberg| first9 = Bart-Jan| last10 = Ostrosky-Zeichner| first10 = Luis| last11 = Reboli| first11 = Annette C.| last12 = Rex| first12 = John H.| last13 = Walsh| first13 = Thomas J.| last14 = Sobel| first14 = Jack D.| last15 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2009-03-01| pmid = 19191635}}</ref> | :* '''Candida spp.'''<ref>{{Cite journal| doi = 10.1086/596757| issn = 1537-6591| volume = 48| issue = 5| pages = 503–535| last1 = Pappas| first1 = Peter G.| last2 = Kauffman| first2 = Carol A.| last3 = Andes| first3 = David| last4 = Benjamin| first4 = Daniel K.| last5 = Calandra| first5 = Thierry F.| last6 = Edwards| first6 = John E.| last7 = Filler| first7 = Scott G.| last8 = Fisher| first8 = John F.| last9 = Kullberg| first9 = Bart-Jan| last10 = Ostrosky-Zeichner| first10 = Luis| last11 = Reboli| first11 = Annette C.| last12 = Rex| first12 = John H.| last13 = Walsh| first13 = Thomas J.| last14 = Sobel| first14 = Jack D.| last15 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2009-03-01| pmid = 19191635}}</ref> | ||
::* Preferred regimen: [[Liposomal Amphotericin B]] | ::* Preferred regimen: [[Liposomal Amphotericin B]] 3–5 mg/kg/day IV {{withorwithout}} [[Flucytosine]] 25 mg/kg PO qid for several weeks, followed by [[Fluconazole]] 400–800 mg (6–12 mg/kg) PO qd until CSF abnl resolves | ||
::* Alternative regimen: [[Fluconazole]] | ::* 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 | ||
::: Note: Removal of intraventricular devices is recommended. | ::: Note: Removal of intraventricular devices is recommended. | ||
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▸ Fluconazole 400 mg PO qd | ▸ Fluconazole 400 mg PO qd | ||
Alternative Regimen | Alternative Regimen | ||
▸ Itraconazole 200 mg PO | ▸ Itraconazole 200 mg PO bid–tid | ||
Adapted from Clin Infect Dis. 2005;41(9):1217-23.[9] | Adapted from Clin Infect Dis. 2005;41(9):1217-23.[9] | ||
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:* '''C. neoformans, HIV–infected''' | :* '''C. neoformans, HIV–infected''' | ||
Induction Therapy: Preferred Regimen 1 | Induction Therapy: Preferred Regimen 1 | ||
▸ Amphotericin B 0. | ▸ Amphotericin B 0.7–1.0 mg/kg IV q24h for ≥2 weeks | ||
OR | OR | ||
▸ Liposomal Amphotericin B | ▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for ≥2 weeks | ||
OR | OR | ||
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks | ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks | ||
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▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks | ▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks | ||
Induction Therapy: Preferred Regimen 2 | Induction Therapy: Preferred Regimen 2 | ||
▸ Amphotericin B 0. | ▸ Amphotericin B 0.7–1.0 mg/kg IV q24h for 4–6 weeks | ||
OR | OR | ||
▸ Liposomal Amphotericin B | ▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for 4–6 weeks | ||
OR | OR | ||
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for | ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4–6 weeks | ||
Induction Therapy: Alternative Regimen 1 | Induction Therapy: Alternative Regimen 1 | ||
▸ Amphotericin B 0.7 mg/kg IV q24h for 2 weeks | ▸ Amphotericin B 0.7 mg/kg IV q24h for 2 weeks | ||
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▸ Flucytosine 100 mg/kg PO q24h for 6 weeks | ▸ Flucytosine 100 mg/kg PO q24h for 6 weeks | ||
Induction Therapy: Alternative Regimen 3 | Induction Therapy: Alternative Regimen 3 | ||
▸ Fluconazole | ▸ Fluconazole 800–2000 mg PO q24h for 10–12 weeks | ||
Induction Therapy: Alternative Regimen 4 | Induction Therapy: Alternative Regimen 4 | ||
▸ Itraconazole 200 mg PO q12h for | ▸ Itraconazole 200 mg PO q12h for 10–12 weeks | ||
Consolidation Therapy | Consolidation Therapy | ||
▸ Fluconazole 400 mg PO q24h for 8 weeks | ▸ Fluconazole 400 mg PO q24h for 8 weeks | ||
| Line 62: | Line 62: | ||
Induction Therapy: Preferred Regimen | Induction Therapy: Preferred Regimen | ||
▸ Liposomal Amphotericin B | ▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for ≥2 weeks | ||
OR | OR | ||
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks | ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks | ||
| Line 68: | Line 68: | ||
▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks | ▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks | ||
Induction Therapy: Alternative Regimen | Induction Therapy: Alternative Regimen | ||
▸ Liposomal Amphotericin B | ▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for 4–6 weeks | ||
OR | OR | ||
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for | ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4–6 weeks | ||
Consolidation Therapy | Consolidation Therapy | ||
▸ Fluconazole | ▸ Fluconazole 400–800 mg PO q24h for 8 weeks | ||
Maintenance Therapy | Maintenance Therapy | ||
▸ Fluconazole | ▸ Fluconazole 200–400 mg PO q24h for 6–12 months | ||
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:* '''C. neoformans, Non–HIV-Infected and Nontransplant Hosts''' | :* '''C. neoformans, Non–HIV-Infected and Nontransplant Hosts''' | ||
Induction Therapy: Preferred Regimen | Induction Therapy: Preferred Regimen | ||
▸ Amphotericin B 0. | ▸ Amphotericin B 0.7–1.0 mg/kg IV q24h for 4–6 weeks | ||
OR | OR | ||
▸ Liposomal Amphotericin B | ▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for 4–6 weeks | ||
OR | OR | ||
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for | ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4–6 weeks | ||
PLUS | PLUS | ||
▸ Flucytosine 25 mg/kg PO q6h for | ▸ Flucytosine 25 mg/kg PO q6h for 4–6 weeks | ||
Consolidation Therapy | Consolidation Therapy | ||
▸ Fluconazole | ▸ Fluconazole 400–800 mg PO q24h for 8 weeks | ||
Maintenance Therapy | Maintenance Therapy | ||
▸ Fluconazole 200 mg PO q24h for | ▸ Fluconazole 200 mg PO q24h for 6–12 months | ||
Adapted from Clin Infect Dis. 2010;50(3):291-322.[10] | Adapted from Clin Infect Dis. 2010;50(3):291-322.[10] | ||
:* '''Histoplasma capsulatum''' | :* '''Histoplasma capsulatum''' | ||
Preferred Regimen | Preferred Regimen | ||
▸ Liposomal Amphotericin B 5 mg/kg IV q24h for | ▸ Liposomal Amphotericin B 5 mg/kg IV q24h for 4–6 weeks | ||
FOLLOWED BY | FOLLOWED BY | ||
▸ Itraconazole 200 mg PO | ▸ Itraconazole 200 mg PO bid–tid for ≥12 months | ||
Adapted from Clin Infect Dis. 2007;45(7):807-25.[11] | Adapted from Clin Infect Dis. 2007;45(7):807-25.[11] | ||
Revision as of 00:32, 20 June 2015
- Fungal meningitis
- Blastomyces dermatitidis[1]
- 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.[2]
- Preferred regimen: Liposomal Amphotericin B 3–5 mg/kg/day IV ± Flucytosine 25 mg/kg PO qid for several weeks, followed by Fluconazole 400–800 mg (6–12 mg/kg) PO qd until CSF abnl resolves
- 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
- Note: Removal of intraventricular devices is recommended.
- 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]
- ↑ 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.
- ↑ Pappas, Peter G.; Kauffman, Carol A.; Andes, David; Benjamin, Daniel K.; Calandra, Thierry F.; Edwards, John E.; Filler, Scott G.; Fisher, John F.; Kullberg, Bart-Jan; Ostrosky-Zeichner, Luis; Reboli, Annette C.; Rex, John H.; Walsh, Thomas J.; Sobel, Jack D.; Infectious Diseases Society of America (2009-03-01). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 48 (5): 503–535. doi:10.1086/596757. ISSN 1537-6591. PMID 19191635.