Version May 2024
| Adults | Children | |
| Amphotericin B* | Liposomal Amphotericin B¶: 3 to 5 mg/kg once daily IV. | Liposomal Amphotericin B¶: 3 to 5 mg/kg once daily IV. |
| Lipid complex Amphotericin B: 5 mg/kg once daily IV. | Lipid complex Amphotericin B: 5 mg/kg once daily IV. | |
| Alternative: Amphotericin B deoxycholate: 0.7 to 1 mg/kg once daily IV. | Alternative: Amphotericin B deoxycholate: 0.7 to 1 mg/kg once daily IV. | |
| Oral itraconazoleΔ◊ | Itraconazole: 200 mg three times daily for three days then 200 mg once to three§ times daily. | |
| Itraconazole (liquid): 200 mg three times daily for three days then 200 mg once to three§ times daily. | Itraconazole (liquid): 5 mg/kg/dose twice daily; maximum dose: 200 mg/dose. | |
| SUBA-itraconazole¥ (capsule): 130 mg three times daily for three days then 130 mg once daily. | ||
| Oral voriconazole◊‡ | Voriconazole 200 to 400 mg twice daily. | <2 years: Oral suspension: 9 mg/kg/dose twice daily, then adjust based on serum trough levels. |
| 2 to <12 years: Oral suspension: 9 mg/kg/dose twice daily; maximum dose: 350 mg/dose. | ||
| 12 to ≤14 years: <50 kg: 9 m/g/kg/dose twice daily; maximum dose: 350 mg/dose. ≥50 kg: 200 mg twice daily. | ||
| >14 years: <40 kg: 100 mg twice daily. ≥40 kg: 200 mg twice daily. |
SUBA: Super-Bioavailable.
* Lipid formulations of amphotericin B are preferred over amphotericin B deoxycholate because of less nephrotoxicity.
¶ For patients with CNS blastomycosis, 5 mg/kg/day should be used.
Δ Adjust dose based on trough serum concentrations. Goal troughs are >1 mcg/mL (although some clinicians prefer >2 mcg/mL) by high-performance liquid chromatography or >3 mcg/mL by bioassay. Itraconazole oral capsules are preferred over other formulations (eg, liquid, SUBA-itraconazole) because of the available effectiveness data and better side effect profile.
◊ Itraconazole and voriconazole are subject to numerous clinically significant drug-drug interactions. Patients receiving azole antifungals should have their medication regimen analyzed for drug interactions when initiating and adjusting therapy; this may be done by use of the Lexi-Interact program within UpToDate. For additional information refer to the clinical topic on pharmacology of azoles.
§ After the 3-day loading dose, once or twice daily dosing of itraconazole dosing is used in mild to moderate blastomycosis in immunocompetent patients. Twice daily itraconazole dosing is used in severe blastomycosis and in immunocompromised patients. Three times daily itraconazole dosing is used in patients with CNS disease as an alternative to voriconazole.
¥ SUBA-itraconazole should not be used for treatment of CNS blastomycosis or in children.
‡ Adjust dose based on trough serum concentrations obtained four to seven days after initiating therapy. Target goal trough is between 1 mcg/mL and 5.5 mcg/mL. Some UpToDate contributors prefer concentrations between 2 and 5.5 mcg/mL.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
