Sandbox carlos

1. Primary pulmonary infection in patients low risk persistence/complication: Antifungal treatment not generally recommended. Treat fever weight loss and/or fatigue.

1.1.1 For many (if not most) patients, management may rely on periodic reassessment of symptoms and radiographic findings to assure resolution without antifungal treatment.
1.1.2 Indications for antifungal therapy:
Immunosupression (AIDS,therapy with high dose corticosteroids, receiptients of TNF-alpha, receiptients of an organ transplant)
Diabetes
Preexisting cardiomyopathy
Pregnancy (third trimester)
Filipino or african
Weight loss of 110%
Intense night sweats persisting longer than 3 weeks
Infiltrates involving more than one-half of one lung or portions of both lungs
Prominent or persistent hilar adenopathy
Anticoccidiodial complement-fixing antibody concentrations in excess of 1:16
1.1.3 Antifungal regimenes
Preferred regimen: Oral azole antifungal agents at dosages of 200–400 mg qd. Courses of typically recommended treatment range from 3 to 6 months.

2. Primary pulmonary infection in patients with increased risk of complications or dissemination:

2.1 Preferred regimen in mild to moderate disease: Itraconazole solution 200 mg PO bid or IV q12h Template:OR Fluconazole 400 mg PO q24h for 3–12 months
2.2 Preferred regimen in locally severe or disseminated disease: Amphotericin B 0.6–1 mg/kg PO qd every 7 days THEN 0.8 mg/kg PO every other day OR liposomal Amphotericin B 3-5 mg/kg IV q24 hrs or Amphotericin B lipid complex 5 mg/kg IV q24 hrs until clinical improvement (usually several weaks or longer in disseminated disease) followed by Itraconazole OR Fluconazole for at least 1 year.
Note (1): Some use combination of Amphotericin B and Fluconazole for progressive severe disease; controlled series lacking.
Note (2): Consultation with specialist recommendation, surgery may be required.

Preferred regimen: Fluconazole 400–1,000 mg po q24h indefinitely
Alternative regimen: Amphotericin B IV as for pulmonary (above) + 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device Template:OR itra 400–800 mg q24h Template:OR Voriconazole
Note (1): Some use combination of Amphotericin B and Flu for progressive severe disease; controlled series lacking.

Preferred regimen: Fluconazole PO (Pediatric dose not established, 6 mg per kg q24h used)
Alternative regimen: Amphotericin B IV as for pulmonary (above) + 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device Template:OR itra 400–800 mg q24h Template:OR Voriconazole

3.1 Focal Pneumonia
3.1.1 Preferred regimen in mild Infections: Fluconazole 400 mg PO daily OR Itraconazole 200 mg PO BID
3.1.2 Alternative regimen in mild infections for patients who failed to respond to fluconazole or itraconazole: Posaconazole 200 mg PO bid OR Voriconazole 200 mg PO bid
Note: Itraconazole, posaconazole, and voriconazole may have significant interactions with certain ARV agents. These interactions are complex and can be bi-directional
3.2 Severe, Non-Meningeal Infection
3.2.1 Preferred regimen in severe, Non-Meningeal Infection (Diffuse Pulmonary Infection or Severely Ill Patients with Extrathoracic, Disseminated Disease): Amphotericin B deoxycholate 0.7–1.0 mg/kg IV qd Lipid formulation amphotericin B 4–6 mg/kg IV daily Duration of therapy: continue until clinical improvement, then switch to an azole
3.2.2 Alternative regimen in severe, Non-Meningeal Infection (Diffuse Pulmonary Infection or Severely Ill Patients with Extrathoracic, Disseminated Disease): Some specialists will add a triazole (fluconazole or itraconazole, with itraconazole preferred for bone disease) 400 mg per day to amphotericin B therapy and continue triazole once amphotericin B is stopped
Note: Therapy should be continued indefinitely in patients with diffuse pulmonary or disseminated diseases because relapse can occur in 25%–33% of HIV-negative patients. It can also occur in HIV-infected patients with CD4 counts >250 cells/μL

3.3 Meningeal Infections
Preferred regimen: Fluconazole 400–800 mg IV or PO daily
Alternative regimen:Itraconazole 200 mg PO TID for 3 days, then 200 mg PO BID (BII), or Posaconazole 200 mg PO BID (BIII), or Voriconazole 200–400 mg PO BID (BIII), or Intrathecal amphotericin B deoxycholate, when triazole antifungals are ineffective.
Note: Intrathecal amphotericin B should only be given in consultation with a specialist and administered by an individual with experience with the technique.:::*Note (1): Some patients with meningitis may develop hydrocephalus and require CSF shunting
Note (2): Therapy should be lifelong in patients with meningeal infections because relapse occurs in 80% of HIV-infected patients after discontinuation of triazole therapy
3.4 Chronic Suppressive Therapy:
Preferred regimen: Fluconazole 400 mg PO daily (AII), or Itraconazole 200 mg PO BID
Alternative regimen: Posaconazole 200 mg PO BID or Voriconazole 200 mg PO BID

Duration of therapy: continue until clinical improvement, then switch to an azole (BIII)

2.2.1 Preferred regimen: Amphotericin B deoxycholate 0.7–1.0 mg/kg IV daily (AII)Lipid formulation amphotericin B 4–6 mg/kg IV daily (AIII) Duration of therapy: continue until clinical improvement, then switch to an azole (BIII)
2.2.2 Alternative regimen: Some specialists will add a triazole (fluconazole or itraconazole, with itraconazole preferred for bone disease) 400 mg per day to amphotericin B therapy and continue triazole once amphotericin B is stopped
2.3 Meningeal Infections:
Preferred regimen:

References