EXAM 5 systemic antifungals Flashcards
candidemia risk factors
broad spectrum ABX
central venous (CVC, PICC)
Receipt of parenteral nutrition (TPN)
Neutropenia (ANC<500 cells/mm)
Receipt of immunosuppressive agents
Surgery
Intraabdominal perforation
Candidemia treatment
start first: echinocandin - micafungin
fluconazole
candidemia treatment duration
treat for 14 days after first negative blood culture
candidemia treatment - neutropenic
Initial therapy: echinocandin
lipid formulation of amphotericin b
either 1
candidemia preferred treatment
fluconazole: albicans, parapsilosis, tropicalis, lusitaniae
Voriconazole: krusei
echinocandins: glabrata, krusei, lusitaniae, auris
amphotericin: parapsilosis, krusei
histoplasmosis clinical presentation
disseminated histoplasmosis: multiple organs
heptaosplenomegaly, chest pain
CNS histoplasmosis symptoms: fever, headache, seizure, mental status
histoplasmosis treatment - immunocompetent host
asymptomatic - no therapy
mild-moderate - intraconazole is DOC for 6-12 weeks
moderate-severe - amphotericin 1-2 weeks then itraconazole for 12 weeks
histoplasmosis treatment - immunocompromised host
therapy required for all patients
moderate-severe - amphotericin 1-2 weeks then itraconazole for 12 weeks
less severe disease: itraconazole for 12 weeks
coccidioidomycosis treatment
most patients with primary pulmonary disease recover without therapy
Primary respiratory infection: fluconazole 3-6 months
Symptomatic chronic cavitary pneumonia: fluconazole 12 month
diffuse pneumonia w/o bilateral or miliary infiltrates: amphotericin B, followed by azole - 12 months
cryptococcosis facts
causitive pathogen: neoformans
cell-mediated immunity plays a major role in host defense against infection
cryptococcosis clinical presentation
pulmonary: cough, rales, SOB
meningitis: mental status change, nuchal rigidity, fever, headache
patients with HIV tend to have less symptoms
cryptococcosis diagnosis
meningitis (most common presentation) - perform lumbar puncture and look at fluid
cryptococcal meningitis treatment - non HIV pts
induction: Amphotericin B + flucytosine for at least 4 weeks
consolidation: fluconazole 400-800 QD for 8 weeks
maintenance: fluconazole 200-400 QD for 6-12 months
cryptococcal meningitis treatment - HIV pts
induction: Amphotericin B + flucytosine for >2 weeks
consolidation: fluconazole 400-800 QD for 8 weeks
maintenance: fluconazole 200-400 QD for 6-12 months
invasive pulmonary aspergillosis treatment
voriconazole
continue therapy for 6-12 weeks
aspergillosis prophylaxis
used for immunocompromised pts
Posaconazole
