Mucormycosis medical therapy: Difference between revisions
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(Created page with "__NOTOC__ {{Mucormycosis}} {{CMG}}; {{AE}}{{HK}} ==Overview== ==Medical Therapy== Antimicrobial Regimen[edit | edit source] Mucormycosis[4] Treatment include surgical debrid...") |
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==Medical Therapy== | ==Medical Therapy== | ||
Antimicrobial Regimen[ | |||
=== Antimicrobial Regimen === | |||
Treatment include surgical debridement of involved tissues, antifungal therapy, use of growth factors to accelerate recovery from neutropenia, provision of granulocyte transfusions with sustained circulating neutrophils until the patient recovers from neutropenia, and discontinuation or reduction in the dose of glucocorticoids, correction of metabolic acidosis and hyperglycemia. | * '''Mucormycosis'''<sup>[[Zygomycosis medical therapy|[4]]]</sup> | ||
Preferred regimen (1): Amphotericin B | :* Treatment include surgical debridement of involved tissues, antifungal therapy, use of growth factors to accelerate recovery from neutropenia, provision of granulocyte transfusions with sustained circulating neutrophils until the patient recovers from neutropenia, and discontinuation or reduction in the dose of glucocorticoids, correction of metabolic acidosis and hyperglycemia. | ||
Preferred regimen (2): | :* Preferred regimen (1): [[Amphotericin B]] Deoxycholate 1.0-1.5 mg/kg/day IV q24h | ||
Preferred regimen (3): Amphotericin B | :* Preferred regimen (2): Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h | ||
Alternative regimen (1):Caspofungin | :* Preferred regimen (3): [[Amphotericin B]] lipid complex 5-7.5 mg/kg/day IV q24h | ||
Pediatric dose: Caspofungin | :* Alternative regimen (1):[[Caspofungin]] 70 mg IV load dose, 50 mg/day for >2 weeks PLUS Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h | ||
Alternative regimen (2): Micafungin | ::* Pediatric dose: [[Caspofungin]] 50 mg/m² IV q24h PLUS Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h | ||
Pediatric dose: Micafungin | :* Alternative regimen (2): [[Micafungin]] OR [[Anidulafungin]] 100 mg/day for 2 weeks PLUS Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h | ||
Alternative regimen (3): Deferasirox | ::* Pediatric dose: [[Micafungin]] 4 mg/kg/day; [[Micafungin]] 10mg/kg/day for low-birth weight infants; [[Anidulafungin]] 1.5 mg/kg/day | ||
Alternative regimen (4): Posaconazole | :* Alternative regimen (3): [[Deferasirox]] 20 mg/kg PO qd for 2–4 weeks PLUS Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h | ||
Alternative regimen (5): Initial: | :* Alternative regimen (4): [[Posaconazole]] 800 mg/day PO qid or bid | ||
Note (1): start maintenance dose 12 to 24 hours after the last loading dose. | :* Alternative regimen (5): Initial: Isavuconazole 200 mg PO/IV q8h for 6 doses; maintenance: 200 mg PO/IV qd | ||
Note (2): For salvage therapy: (Posaconazole | :* Note (1): start maintenance dose 12 to 24 hours after the last loading dose. | ||
:* Note (2): For salvage therapy: ([[Posaconazole]] 800 mg/day PO qid or bid ± Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h) OR ([[Deferasirox]] 20 mg/kg PO qd for 2–4 weeks PLUS Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h) OR Granulocyte transfusions (for persistently neutropenic patients) ∼10ˆ9 cells/kg OR Recombinant cytokines G-CSF 5 μg/kg/day, GM-CSF 100–250 μg/m², or IFN-g at 50 μg/m² for those with body surface area ≥ 0.5 m² and 1.5 μg/kg for those with body surface area <0.5 m² | |||
Revision as of 17:35, 6 June 2017
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Mucormycosis Microchapters |
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Diagnosis |
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Treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
Medical Therapy
Antimicrobial Regimen
- Mucormycosis[4]
- Treatment include surgical debridement of involved tissues, antifungal therapy, use of growth factors to accelerate recovery from neutropenia, provision of granulocyte transfusions with sustained circulating neutrophils until the patient recovers from neutropenia, and discontinuation or reduction in the dose of glucocorticoids, correction of metabolic acidosis and hyperglycemia.
- Preferred regimen (1): Amphotericin B Deoxycholate 1.0-1.5 mg/kg/day IV q24h
- Preferred regimen (2): Lipid Amphotericin B 5-10 mg/kg/day IV q24h
- Preferred regimen (3): Amphotericin B lipid complex 5-7.5 mg/kg/day IV q24h
- Alternative regimen (1):Caspofungin 70 mg IV load dose, 50 mg/day for >2 weeks PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h
- Pediatric dose: Caspofungin 50 mg/m² IV q24h PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h
- Alternative regimen (2): Micafungin OR Anidulafungin 100 mg/day for 2 weeks PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h
- Pediatric dose: Micafungin 4 mg/kg/day; Micafungin 10mg/kg/day for low-birth weight infants; Anidulafungin 1.5 mg/kg/day
- Alternative regimen (3): Deferasirox 20 mg/kg PO qd for 2–4 weeks PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h
- Alternative regimen (4): Posaconazole 800 mg/day PO qid or bid
- Alternative regimen (5): Initial: Isavuconazole 200 mg PO/IV q8h for 6 doses; maintenance: 200 mg PO/IV qd
- Note (1): start maintenance dose 12 to 24 hours after the last loading dose.
- Note (2): For salvage therapy: (Posaconazole 800 mg/day PO qid or bid ± Lipid Amphotericin B 5-10 mg/kg/day IV q24h) OR (Deferasirox 20 mg/kg PO qd for 2–4 weeks PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h) OR Granulocyte transfusions (for persistently neutropenic patients) ∼10ˆ9 cells/kg OR Recombinant cytokines G-CSF 5 μg/kg/day, GM-CSF 100–250 μg/m², or IFN-g at 50 μg/m² for those with body surface area ≥ 0.5 m² and 1.5 μg/kg for those with body surface area <0.5 m²