Template:ID-Fungal meningitis: Difference between revisions

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:* '''Candida spp.'''<ref>{{Cite journal| doi = 10.1086/596757| issn = 1537-6591| volume = 48| issue = 5| pages = 503–535| last1 = Pappas| first1 = Peter G.| last2 = Kauffman| first2 = Carol A.| last3 = Andes| first3 = David| last4 = Benjamin| first4 = Daniel K.| last5 = Calandra| first5 = Thierry F.| last6 = Edwards| first6 = John E.| last7 = Filler| first7 = Scott G.| last8 = Fisher| first8 = John F.| last9 = Kullberg| first9 = Bart-Jan| last10 = Ostrosky-Zeichner| first10 = Luis| last11 = Reboli| first11 = Annette C.| last12 = Rex| first12 = John H.| last13 = Walsh| first13 = Thomas J.| last14 = Sobel| first14 = Jack D.| last15 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2009-03-01| pmid = 19191635}}</ref>
:* '''Candida spp.'''<ref>{{Cite journal| doi = 10.1086/596757| issn = 1537-6591| volume = 48| issue = 5| pages = 503–535| last1 = Pappas| first1 = Peter G.| last2 = Kauffman| first2 = Carol A.| last3 = Andes| first3 = David| last4 = Benjamin| first4 = Daniel K.| last5 = Calandra| first5 = Thierry F.| last6 = Edwards| first6 = John E.| last7 = Filler| first7 = Scott G.| last8 = Fisher| first8 = John F.| last9 = Kullberg| first9 = Bart-Jan| last10 = Ostrosky-Zeichner| first10 = Luis| last11 = Reboli| first11 = Annette C.| last12 = Rex| first12 = John H.| last13 = Walsh| first13 = Thomas J.| last14 = Sobel| first14 = Jack D.| last15 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2009-03-01| pmid = 19191635}}</ref>
::* Preferred regimen: [[Liposomal Amphotericin B]] 3—5 mg/kg/day IV {{withorwithout}} [[Flucytosine]] 25 mg/kg PO qid for several weeks, followed by [[Fluconazole]] 400—800 mg (6—12 mg/kg) PO qd
::* Preferred regimen: [[Liposomal Amphotericin B]] 3—5 mg/kg/day IV {{withorwithout}} [[Flucytosine]] 25 mg/kg PO qid for several weeks, followed by [[Fluconazole]] 400—800 mg (6—12 mg/kg) PO qd until CSF abnl resolves
::* Alternative regimen: [[Fluconazole]] 400—800 mg PO qd (6—12 mg/kg IV q24h) {{or}} [[Voriconazole]] 400 mg PO bid for 2 doses, followed by 200 mg PO bid {{or}} [[Voriconazole]] 6 mg/kg IV q12h for 2 doses, followed by 3 mg/kg IV q12h
::* Alternative regimen: [[Fluconazole]] 400—800 mg PO qd (6—12 mg/kg IV q24h) {{or}} [[Voriconazole]] 400 mg PO bid for 2 doses, followed by 200 mg PO bid {{or}} [[Voriconazole]] 6 mg/kg IV q12h for 2 doses, followed by 3 mg/kg IV q12h
 
::: Note: Removal of intraventricular devices is recommended.





Revision as of 00:31, 20 June 2015

  • Fungal meningitis
  • Blastomyces dermatitidis[1]
  • Candida spp.[2]
  • Preferred regimen: Liposomal Amphotericin B 3—5 mg/kg/day IV ± Flucytosine 25 mg/kg PO qid for several weeks, followed by Fluconazole 400—800 mg (6—12 mg/kg) PO qd until CSF abnl resolves
  • Alternative regimen: Fluconazole 400—800 mg PO qd (6—12 mg/kg IV q24h) OR Voriconazole 400 mg PO bid for 2 doses, followed by 200 mg PO bid OR Voriconazole 6 mg/kg IV q12h for 2 doses, followed by 3 mg/kg IV q12h
Note: Removal of intraventricular devices is recommended.


  • Coccidioides immitis

Preferred Regimen ▸ Fluconazole 400 mg PO qd Alternative Regimen ▸ Itraconazole 200 mg PO bid—tid Adapted from Clin Infect Dis. 2005;41(9):1217-23.[9]



  • C. neoformans, HIV–infected

Induction Therapy: Preferred Regimen 1 ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for ≥2 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for ≥2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks PLUS ▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks Induction Therapy: Preferred Regimen 2 ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for 4—6 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for 4—6 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4—6 weeks Induction Therapy: Alternative Regimen 1 ▸ Amphotericin B 0.7 mg/kg IV q24h for 2 weeks PLUS ▸ Fluconazole 800 mg PO q24h for 2 weeks Induction Therapy: Alternative Regimen 2 ▸ Fluconazole 1200 mg PO q24h for 6 weeks PLUS ▸ Flucytosine 100 mg/kg PO q24h for 6 weeks Induction Therapy: Alternative Regimen 3 ▸ Fluconazole 800—2000 mg PO q24h for 10—12 weeks Induction Therapy: Alternative Regimen 4 ▸ Itraconazole 200 mg PO q12h for 10—12 weeks Consolidation Therapy ▸ Fluconazole 400 mg PO q24h for 8 weeks Maintenance Therapy ▸ Fluconazole 200 mg PO q24h for ≥1 year OR ▸ Itraconazole 400 mg PO q24h for ≥1 year OR ▸ Amphotericin B 1.0 mg/kg/week IV for ≥1 year


  • C. neoformans, Organ Transplant Recipients

Induction Therapy: Preferred Regimen ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for ≥2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks PLUS ▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks Induction Therapy: Alternative Regimen ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for 4—6 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4—6 weeks Consolidation Therapy ▸ Fluconazole 400—800 mg PO q24h for 8 weeks Maintenance Therapy ▸ Fluconazole 200—400 mg PO q24h for 6—12 months


  • C. neoformans, Non–HIV-Infected and Nontransplant Hosts

Induction Therapy: Preferred Regimen ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for 4—6 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for 4—6 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4—6 weeks PLUS ▸ Flucytosine 25 mg/kg PO q6h for 4—6 weeks Consolidation Therapy ▸ Fluconazole 400—800 mg PO q24h for 8 weeks Maintenance Therapy ▸ Fluconazole 200 mg PO q24h for 6—12 months Adapted from Clin Infect Dis. 2010;50(3):291-322.[10]

  • Histoplasma capsulatum

Preferred Regimen ▸ Liposomal Amphotericin B 5 mg/kg IV q24h for 4—6 weeks FOLLOWED BY ▸ Itraconazole 200 mg PO bid—tid for ≥12 months Adapted from Clin Infect Dis. 2007;45(7):807-25.[11]

  1. Chapman, Stanley W.; Dismukes, William E.; Proia, Laurie A.; Bradsher, Robert W.; Pappas, Peter G.; Threlkeld, Michael G.; Kauffman, Carol A.; Infectious Diseases Society of America (2008-06-15). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 46 (12): 1801–1812. doi:10.1086/588300. ISSN 1537-6591. PMID 18462107.
  2. Pappas, Peter G.; Kauffman, Carol A.; Andes, David; Benjamin, Daniel K.; Calandra, Thierry F.; Edwards, John E.; Filler, Scott G.; Fisher, John F.; Kullberg, Bart-Jan; Ostrosky-Zeichner, Luis; Reboli, Annette C.; Rex, John H.; Walsh, Thomas J.; Sobel, Jack D.; Infectious Diseases Society of America (2009-03-01). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 48 (5): 503–535. doi:10.1086/596757. ISSN 1537-6591. PMID 19191635.