Fungal Infections Flashcards
Echinocandins
CRAM
Caspofungin
Rezafungin
Anidulafungin
Micafungin
Candidemia treatment
- Any echinocandin
- Fluconazole IF known susceptibility (400mg daily)
- Amphotericin B lipid (if resistant)
Treat 14 days (after first negative blood culture)
Endocarditis d/t candida
- Amphotericin B lipid + flucytosine OR high dose echinocandin
- Fluconazole, voriconazole, posaconazole for step down therapy, if sensitive
Replace heart valve. Treat for 6 weeks.
If unable to replace valve, fluconazole suppressive therapy needed
Osteomyelitis or Septic arthritis d/t candida
- Fluconazole for 6-12 months
- Echinocandin x2 weeks followed by fluconazole for 6-12 months
- Amphotericin B lipid x2 weeks followed by fluconazole for 6-12 months
Septic arthritis is only 6 weeks but same therapy.
UTI d/t candida
- Remove indwelling catheter, stent, nephrostomy tubes
- Treat asymptomatic patients IF neutropenic or undergoing urologic manipulation
- Fluconazole x2 weeks
- Fluconazole resistant: Amphotericin B deoxycholate x1-7 OR flucytosine x7-10 days
Other -azoles and echinocandins do not achieve adequate urinary concentrations.
Invasive Candidiasis in ICU tx
Treat if unexplained fever and risk factors (severe illness, broad spectrum ABX, abdominal surg, TPN, steroids, CVC, nec pancreatitis, candida colonization)
- Use Echinocandin
- Use fluconazole IF no recent azole use or colonization with azole-resistant organisms
- Use AmpB lipid IF intolerant to other antifungals
Treat for 2 weeks if response.
No response, treat 4-5 days.
Histoplasmosis treatment
Moderate to severe:
1. Amphotericin B lipid 3-5 mg/kg/day for 1-2 weeks
2. THEN itraconzaole to complete 12 weeks
Mild:
1. Itrazonazole 200mg TID x3 days, then BID x12 weeks
Coccidioidomycosis treatment
- Immunocompetent: may not need to treat
- Fluconazole 400mg daily OR itraconazole 200mg BID x3-6 months
- Severe disease: amphotericin B lipid until improvement, then fluconazole or itraconazole for at least a year
Blastomycosis treatment
- Itraconazole 200mg TID x3 days, then BID for 24 weeks
- Severe: lipid amphotericin B until improvement and then itraconazole x6-12 months
Aspergillosis treatment
- Voriconazole 6mg/kg IV BID x2 doses, then 4mg/kg IV BID OR 200-300mg PO BID (prefer oral)
Alt: isavuconazole 200mg q8h x6 doses, then 200mg daily
Alt: Amp B lipid
Alt: Echinocandin IF azole and ampB contraindicated
Treat 6-12 weeks
Aspergillosis prophylaxis
High risk patients - prolonged neutropenia, graft-vs-host, lung transplant
Voriconazole, itraconazole, posaconazole, isavuconazole, inhaled amphotericin
Aspergillosis is universally fatal in bone marrow transplant patients
Mucormycosis treatment
Removal of infected tissue
1. Amphotericin B lipid 5-10 mg/kg/day
2. May add isavuconazole or posaconazole until improvement
3. Then, isavuconazole or posaconazole monotherapy for months
Tinea capitis treatment
Scalp infection
- Griseofulvin (pref. if microsporum) 10-15 mg/kg/day x4-12 weeks
- Terbinafine (pref. if trichophyton) weight based for 4 weeks
Alt: itraconazole or fluconazole x4-6 weeks
Selenium sulfide 2.5% shampoo reduces spread
Dermophytes
Microsporum
Trichophyton
Epidermophyton
Cause tinea infections
Tinea pedis
Foot infection
Topical antifungal BID until clear
Severe/resistant: terbinafine, itraconazole, fluconazole
