Paracoccidioidomycosis medical therapy: Difference between revisions
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Pharmacologic medical therapy is indicated in paracoccidioidomycosis. The preferred regimens for both mild and moderate-to-severe include [[antifungals]] either [[azoles]] (such as [[itraconazole]], [[ketoconazole]], [[voriconazole]]) or [[amphotericin B]] and [[antimicrobials]] such as [[Trimethoprim-Sulfamethoxazole|trimethoprim-sulfamethoxazole]].<ref name="pmid24173174">{{cite journal| author=Marques SA| title=Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating. | journal=An Bras Dermatol | year= 2013 | volume= 88 | issue= 5 | pages= 700-11 | pmid=24173174 | doi=10.1590/abd1806-4841.20132463 | pmc=PMC3798345 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24173174 }} </ref> | Pharmacologic medical therapy is indicated in paracoccidioidomycosis. The preferred regimens for both mild and moderate-to-severe include [[antifungals]] either [[azoles]] (such as [[itraconazole]], [[ketoconazole]], [[voriconazole]]) or [[amphotericin B]] and [[antimicrobials]] such as [[Trimethoprim-Sulfamethoxazole|trimethoprim-sulfamethoxazole]].<ref name="pmid24173174">{{cite journal| author=Marques SA| title=Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating. | journal=An Bras Dermatol | year= 2013 | volume= 88 | issue= 5 | pages= 700-11 | pmid=24173174 | doi=10.1590/abd1806-4841.20132463 | pmc=PMC3798345 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24173174 }} </ref> | ||
==Medical Therapy== | |||
*'''Paracoccidioidomycosis'''<ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260 }} </ref> | *'''Paracoccidioidomycosis'''<ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260 }} </ref> | ||
:* Preferred regimen (1): | :* Preferred regimen (1): | ||
Latest revision as of 22:06, 12 February 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac
Overview
Pharmacologic medical therapy is indicated in paracoccidioidomycosis. The preferred regimens for both mild and moderate-to-severe include antifungals either azoles (such as itraconazole, ketoconazole, voriconazole) or amphotericin B and antimicrobials such as trimethoprim-sulfamethoxazole.[1]
Medical Therapy
- Paracoccidioidomycosis[2]
- Preferred regimen (1):
- Adults: Itraconazole 200 mg/day PO
- Children: Itraconazole (<30/kg and >5 yr) 5-10 mg/kg/day PO
- Note: Treatment duration based on organ involvement:
- Mild involvement: 6-9 months
- Moderate involvement: 12-18 months
- Preferred regimen (2)
- Adults: Trimethoprim/sulfamethoxazole (TMP/SMX) TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV bid
- Children: Trimethoprim/sulfamethoxazole (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, bid
- Note (1): Treatment duration based on organ involvement:
- Minor involvement: 12 months
- Moderate involvement: 18-24 months
- Note (2): Preferred treatment in children due to larger experience.
- Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.
- Preferred regimen (3): Amphotericin B deoxycholate 1 mg/kg/day IV until patient improves and can be treated by the oral route.
- Note: Preferred in severe forms of the disease.
- Alternative regimen (4): Ketoconazole 200-400 mg/day PO for 9-12 months
- Alternative regimen (5): Voriconazole initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months[3]
- Note: Diminish the dose to 50% if weight is <40 kg.
References
- ↑ Marques SA (2013). "Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating". An Bras Dermatol. 88 (5): 700–11. doi:10.1590/abd1806-4841.20132463. PMC 3798345. PMID 24173174.
- ↑ Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML (2006). "[Guidelines in paracoccidioidomycosis]". Rev Soc Bras Med Trop. 39 (3): 297–310. PMID 16906260.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.