Antifungals

Question 1

Candidiasis Tx

Answer 1

First-line
-Echinocandin like Caspo/micafungin
-Fluconazole in select pts

Duration: 2 weeks after clearance of Candida from blood and resolution of sx

Question 2

Empiric Candidemia Dosing

Answer 2

-Caspo: 70 mg LD, 50 mg MD QD
-Mica: 100 mg QD
-Anidula: 200 mg LD, 100 mg MD QD

-Fluconazole: 800 mg LD, 400 mg MD QD
-Voriconazole: 400 mg x 2 LD, 200 mg MD BID

-Amph B: 3-5 mg/kg IV QD

Question 3

Antifungal Prophylaxis: Candida

Answer 3

Consider for:
-Organ transplant
-Chemo neutropenia
-Stem cell transplant
-ICU high risk pts > 5%

DOC:
-Fluconazole

Question 4

Aspergillosis Tx

Answer 4

First-line: VAIEP
-Voriconazole
-Alt: Amph B, Isavuconazole (these are primary alt)
*Echinocandins (E = not mono)
-Off-label: Posaconazole

Duration: 6-12 weeks

Drug monitoring recommended (troughs)

Question 5

Empiric Asper Dosing (new ones)

Answer 5

-Isavuconazole: 200 mg Q8 x 6 doses, then 200 mg QD

-Posa: 300 mg Q12 x 2 doses, then 300 mg QD

Question 6

Antifungal Prophylaxis: Asper

Answer 6

Consider for:
-Organ transplant
-Chemo neutropenia
-Stem cell transplant

DOC:
-Voriconazole, Posaconazole

Question 7

Coccidioidomycosis (valley fever) + Tx

Answer 7

Asymp or Symp
-Fever, cough, dyspnea, HA, night sweats, chest pain

Tx
-DOC: Fluconazole 400 mg QD
-Alt: Itraconazole, Amph B (if azalea fails)

Duration: 3-6 months

Question 8

Amph B AEs

Answer 8

-Nephrotoxicity
-Electrolyte abnormalities
-Infusion rxns

Question 9

Itraconazole

Answer 9

Take with food or acidic drink

Question 10

Azoles AEs

Answer 10

All (HQR)
-Hepatic, rash, QTc pro

Itra (CIG)
-GI, cardio

Vori (VPofPC)
-CNS, photopsia, photosensitivity

Question 11

Echinocandins

Answer 11

-Poor GI abs = IV
-Dose adj in hepatic (caspo)
-AE: photosensitivity/infusion rxn