Fungal infections Flashcards
Which azole is not recommended in CrCL less than 50 mL/min?
Voriconazole
Which azole has solution and capsule formulations that are not interchangeable?
Itraconazole
Which azoles have therapeutic drug monitoring?
Voriconazole, posaconazole
Which azole can replace voriconazole in pts with renal issues?
Isavuconazole
Echinocandin - formulation
Only available IV
Echinocandin - loading dose for which?
Capsofungin and anidulafungin
NOT micafungin
Pretreatments for amphotericin?
Infusion related side effects - chills, rigor, fever
Pre-treat with APAP and diphenhydramine
Renal toxicity - give normal saline before and after
There can be electrolyte wasting so may have to treat that
Which drug must be used in combination?
Flucytosine
Which drug can cause bone marrow suppression?
Flucytosine
How to treat Candidemia?
Echinocandin first line
Fluconazole IV/PO 800 mg loading then 400 mg daily OK if not critically ill/no resistance (no recent azole use)
Duration: Clearance of blood culture plus 2 weeks
When do you check for azole susceptibility?
All patients
When do you check for echinocandin susceptibility?
In patients with prior use or infected with C glabrata or C parapsilosis
What is candiduria? When do we treat?
Candida part of the urogenital normal flora
Onlu treat if symptomatic, neutropenic, very low birth weight neonate, or urologic manipulation occurred
How to treat candiduria?
Fluconazole oral
What is vulvovaginal candidiasis?
Yeast infection
Uncomplicated: Sporadic, responds to any/all antifungals
Complicated: Recurrent, severe, non-C albicans species, host factors (immunosuppression)
How to treat vulvovaginal candidiasis?
Uncomplicated: Topical azoles, or fluconazole 150 mg 1 dose
Severe, acute: Fluconazole 150 mg q72 hours x 2-3 doses
Recurrent: 10-14 days induction with topical or oral azole, then fluconazole 150 mg every week for 6 months
Nonresponsive C glabrata infection: Boric acid, nystatin, or flucytosine with or without amphotericin B cream
How to treat OPC?
Oropharyngeal candidiasis:
Mild disease use clotrimazole troches, miconazole mucoadhesive buccal tablets
Moderate/severe: Fluconazole
Duration: 7-14 days
How to treat EC?
Esophageal candidiasis
MUST use systemic treatment
Preferred: Fluconazole 200-400 mg PO daily x 14-21 days (3-6 mg/kg)
Can use Fluconazole 400 mg IV or Echinocandin if PO cannot be tolerated (bc you know it’s esophageal)
How to treat Pulmonary aspergillosis?
EARLY
Use voriconazole IV or PO 6 mg/kg q12h for 1 day then 4 mg/kg every 12 hours
Duration: 6-12 weeks at least
Immunosuppressed pts: Continue during immunosuppression and while lesions are present
Immunosuppressant patients successfully treated requiring continued immunosuppression should continue treatment bc they’re still at risk for another infection
