Paracoccidioidomycosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac

Overview

Pharmacologic medical therapy is indicated in paracoccidioidomycosis. The preferred regimens for both mild and moderate-to-severe include antifungals either azoles (such as itraconazole, ketoconazole, voriconazole) or amphotericin B and antimicrobials such as trimethoprim-sulfamethoxazole.[1]

Medical Therapy

  • Paracoccidioidomycosis[2]
  • Preferred regimen (1):
  • Adults: Itraconazole 200 mg/day PO
  • Children: Itraconazole (<30/kg and >5 yr) 5-10 mg/kg/day PO
  • Note: Treatment duration based on organ involvement:
  • Mild involvement: 6-9 months
  • Moderate involvement: 12-18 months
  • Preferred regimen (2)
  • Minor involvement: 12 months
  • Moderate involvement: 18-24 months
  • Note (2): Preferred treatment in children due to larger experience.
  • Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.
  • Preferred regimen (3): Amphotericin B deoxycholate 1 mg/kg/day IV until patient improves and can be treated by the oral route.
  • Note: Preferred in severe forms of the disease.
  • Alternative regimen (4): Ketoconazole 200-400 mg/day PO for 9-12 months
  • Alternative regimen (5): Voriconazole initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months[3]
  • Note: Diminish the dose to 50% if weight is <40 kg.

References

  1. Marques SA (2013). "Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating". An Bras Dermatol. 88 (5): 700–11. doi:10.1590/abd1806-4841.20132463. PMC 3798345. PMID 24173174.
  2. Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML (2006). "[Guidelines in paracoccidioidomycosis]". Rev Soc Bras Med Trop. 39 (3): 297–310. PMID 16906260.
  3. Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.