Paracoccidioidomycosis medical therapy
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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.