ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Management of Candida infections involving cardiac implantable electronic devices in adults

Management of Candida infections involving cardiac implantable electronic devices in adults
Condition or treatment group Therapy
Primary Step-down Comments
Candida infections involving cardiac implantable electronic devices
Implantable cardiac defibrillator or pacemaker

  • A lipid formulation of amphotericin B (3 to 5 mg/kg IV daily) with or without flucytosine* (25 mg/kg orally four times daily);

OR

  • High-dose echinocandin (caspofungin 150 mg IV daily, micafungin 150 mg IV daily, or anidulafungin 200 mg IV daily).
  • For patients who are clinically stable, have isolates that are susceptible to fluconazole, and have negative repeat blood cultures following initiation of a lipid formulation of amphotericin B or high-dose echinocandin therapy, transition to oral fluconazole 400 to 800 mg (6 to 12 mg/kg) daily is appropriate.
  • Oral voriconazoleΔ 200 to 300 mg (3 to 4 mg/kg) twice daily or posaconazoleΔ delayed-release tablets 300 mg daily can be used for step-down therapy in clinically stable patients who have isolates susceptible to these agents but not susceptible to fluconazole.
  • Removal of the entire device is strongly recommended.
  • For infections limited to generator pockets, 4 weeks of antifungal therapy following device removal is recommended.
  • For infections involving device wires, antifungal therapy should continue for at least 6 weeks after wire removal. Some specialists prefer lifelong oral suppressive therapy after lead removal, especially if there is possible endocardial infection or if a new device is implanted.
The doses above are intended for adults with normal organ function. The dose of fluconazole and flucytosine must be adjusted in the setting of renal insufficiency; the caspofungin and voriconazole dose may require adjustment in hepatic insufficiency. Refer to the Lexicomp drug-specific monographs for additional information including specific dose adjustment recommendations.
IV: intravenous; VAD: ventricular assist device.
* Toxic effects on bone marrow and liver require careful monitoring preferably with frequent serum flucytosine levels; refer to accompanying text for discussion of benefits and risks of combined flucytosine and amphotericin B therapy.
¶ Since fluconazole is highly bioavailable, oral therapy is appropriate for most patients. IV therapy (at the same dose) should be given to patients who are unable to take oral medications, who are not expected to have good gastrointestinal absorption, or who are severely ill.
Δ Therapeutic drug monitoring should be considered; refer to the topic review on pharmacology of azoles for details.
◊ In patients with endocarditis caused by a Candida species that is not susceptible to fluconazole, oral voriconazole (200 or 300 mg [3 to 4 mg/kg] twice daily) or delayed-release posaconazole tablets (300 mg daily) should be used for chronic suppressive therapy if the organism is susceptible.
Data from: Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2015; 62:e1.
Graphic 107269 Version 1.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟