Sandbox carlos
- Coccidioidomycosis
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- 1.Primary pulmonary infection in patients low risk persistence/complication: Antifungal treatment not generally recommended. Treat fever weight loss and/or fatigue.
- 1.1 Primary pulmonary infection in patients with increased risk of complications or dissemination:
- Mild to moderate severity.Preferred regimen: Itraconazole solution 200 mg po or IV bid Template:OR Fluconazole 400 mg po q24h for 3–12 mo
- Locally severe or disseminated disease:
- Ampho B 0.6–1 mg/kg per day x 7 days then 0.8 mg/kg every other day or liposomal ampho B 3-5 mg/kg/d IV or ABLC 5 mg/kg/d IV, until clinical improvement (usually several wks or longer in disseminated disease), followed by itra or flu for at least 1 year.
- Some use combination of Ampho B & Flu for progressive severe disease; controlled series lacking.
- Note: Consultation with specialist recommended: surgery may be required.
- Meningitis:
- Adult:
- Preferred regimen: Fluconazole 400–1,000 mg po q24h indefinitely
- Alternative regimen: Ampho B IV as for pulmonary (above) + 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device. OR itra 400–800 mg q24h OR voriconazole
- Some use combination of Ampho B & Flu for progressive severe disease; controlled series lacking.
- Child
- Preferred regimen: Fluconazole (po) (Pediatric dose not established, 6 mg per kg q24h used)
- Alternative regimen: Ampho B IV as for pulmonary (above) + 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device. OR itra 400–800 mg q24h OR voriconazole
==References==