Blastomycosis medical therapy
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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]
Overview
Medical Therapy
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 treated, otherwise all cases need therapy.
- Immuno-competent patient.(Non-Life threatening infection)
- Drug of choice in this cases is usually Itraconazole or Lipid Amphotericin B. Alternatively, daily fluconazole or ketaconazole may also be used.
- Immuno-competent 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.
- Immuno-compromised patients.
- All patients warrant treatment with Lipid Amphotericin B as the drug of choice and Itraconazole once the disease has shown clinical improvement.
Antimicrobial Regimen
- Blastomycosis
- Mild to moderate pulmonary blastomycosis
- Preferred regimen: Itraconazole 200 mg PO once or twice per day for 6–12 months
- Note: oral Itraconazole, 200 mg 3 times per day for 3 days and then once or twice per day for 6–12 months, is recommended
- Moderately severe to severe pulmonary blastomycosis
- Preferred regimen(1): Lipid amphotericin B(Lipid AmB), 3–5 mg/kg per day, for 1–2 weeks, followed by Itraconazole, 200 mg PO bid for 6–12 months
- Preferred regimen(2):Deoxycholate amphotericin B, 0.7–1 mg/kg per day, for 1–2 weeks, followed by Itraconazole, 200 mg PO bid for 6–12 months
- Note: oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
- Mild to moderate disseminated blastomycosis
- Preferred regimen:
- Moderately severe to severe disseminated blastomycosis
- Preferred regimen:
- CNS disease
- Preferred regimen:
- Immunosuppressed patients
- Preferred regimen:
- Pregnant women
- Preferred regimen:
- Children with mild to moderate disease
- Preferred regimen:
- Children with moderately severe to severe disease
- Preferred regimen: