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Clostridium

  • Antibiotics are not recommended in gastrointestinal botulism due to the risk of worsening of neurological symptoms caused by the lysis of the bacteria. For wound botulism antibiotics are indicated with surgical treatment as followed:
  • 2. Antitoxin [1]
  • Preferred regimen: Trivalent antitoxin (A 7,500 IU, B 5,000 IU, and E 5,000 IU) 1 vial diluted 1:10, IV infusion over 30 min
  • Alternative regimen: Equine antitoxin
  • 3. General Therapy
  • Preferred regimen: Mechanical ventilation; IV hydration; tube feedings
  • Clostridium perfringens [2]
  • Gas gangrene
  • 1. General measures
  • Preferred regimen: Patients should be placed in a quiet shaded area and protected from tactile and auditory stimulation as much as possible; All wounds should be cleaned and debrided as indicated
  • 2. Immunotherapy
  • Preferred regimen: Human TIG 500 units by intramuscular injection or intravenously as soon as possible AND Age-appropriate TT-containing vaccine, 0.5 cc by intramuscular injection at a separate site
  • Note: patients without a history of primary TT vaccination should receive a second dose 1–2 months after the first dose and a third dose 6–12 months later
  • 3. Antibiotic treatment
  • 4. Muscle spasm control
  • Preferred regimen: Diazepam 5 mg intravenous OR Lorazepam 2 mg titrating to achieve spasm control without excessive sedation and hypoventilation
  • Alternative regimen (1): Magnesium sulphate 5 gm (or 75mg/kg) intravenous loading dose, then 2–3 grams per hour until spasm control is achieved ± Benzodiazepines
  • Note: Monitor patellar reflex as areflexia (absence of patellar reflex) occurs at the upper end of the therapeutic range (4mmol/L). If areflexia develops, dose should be decreased
  • Alternative regimen (2): Baclofen OR Dantrolene 1–2 mg/kg intravenous/orally every 4 hours
  • Alternative regimen (3): Barbiturates 100–150 mg every 1–4 hours by any route
  • Alternative regimen (4): Chlorpromazine 50–150 mg by intramuscular injection every 4–8 hours
  • Pediatric regimen: Lorazepam 0.1–0.2 mg/kg every 2–6 hours, titrating upward as needed; Barbiturates 6–10 mg/kg in children by any route; Chlorpromazine 4–12 mg every by intramuscular injection every 4–8 hours
  • Note: As for Benzodiazepines, large amounts may be required (up to 600 mg/day); Oral preparations could be used but must be accompanied by careful monitoring to avoid respiratory depression or arrest
  • 5. Autonomic dysfunction control
  • 1.Diphtheria treatment[4]
  • 1.1 Antitoxin
  • Preferred regimen: 20,000-40,000 U pharyngeal disease <48 hrs; 40-60,000 U nasopharyngeal; 80-120,000 U for extensive disease, brawny neck or sx >72 hrs; Adiminister IV (severe disease) or IM
  • 1.2 Antibiotics:
  • Preferred regimen: Procaine Penicillin G (<20 lbs: 300,000 U; >20 lbs: 600,000 U) IM q12h until patient can swallow then Penicillin VK 125-250 mg PO QID OR Erythromycin 125-500 mg PO QID for 14 days total.
  • Alternative regimen (1): Erythromycin 20-25mg/kg IV q6h (max 4g/day; β-lactam allergic patients)
  • Alternative regimen (2): Clindamycin 600 mg IV q8h
  • 2.C. diphtheriae carrier
  • 3.Endocarditis treatment
  • Corynebacterium jeikeium[5]
  • Corynebacterium urealyticum[6]

Plasmodium

  • 1.1 Treatment of uncomplicated P. falciparum malaria
  • 1.1.1 Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)
  • Preferred regimen (1): Artemether 5–24 mg/kg/day PO bid AND Lumefantrine 29–144 mg/kg/day PO bid for 3 days.
  • Note: The first two doses should, ideally, be given 8 h apart.
  • Preferred regimen (2): Artesunate 2–10 mg/kg/day PO qd AND Amodiaquine 7.5–15 mg/kg/day PO qd for 3 days
  • Note: A total therapeutic dose range of 6–30 mg/kg/day artesunate and 22.5–45 mg/kg/day per dose amodiaquine is recommended.
  • Preferred regimen (3): Artesunate 2–10 mg/kg/day PO qd AND Mefloquine 2–10 mg/kg/day PO qd for 3 days
  • Preferred regimen (4): Artesunate 2–10 mg/kg/day PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1.25 (25–70 / 1.25–3.5) mg/kg/day PO given as a single dose on day 1
  • 1.1.2 Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)
  • Preferred regimen: Single dose of 0.25 mg/kg Primaquine with ACT
  • 1.2 Recurrent Falciparum Malaria
  • 1.2.1 Failure within 28 days
  • Note:The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens (with artesunate or quinine both of which should be co-administered with + tetracycline, or doxycycline or clindamycin) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.
  • 1.2.2 Failure after 28 days
  • Note: all presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of mefloquine within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used.
  • 1.3 Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)
  • Note: Single dose of 0.25 mg/kg bw Primaquine with ACT
  • 1.4 Treating uncomplicated P. falciparum malaria in special risk groups
  • 1.4.1 Pregnancy
  • First trimester of pregnancy : Quinine AND Clindamycin 10mg/kg/day PO bid for 7 days
  • Second and third trimesters : Mefloquine is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
  • Note (1): Quinine is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
  • Note (2): Primaquine and tetracyclines should not be used in pregnancy.
  • 1.4.2 Infants less than 5kg body weight : with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.
  • 1.4.3 Patients co-infected with HIV: should avoid Artesunate + SP if they are also receiving Co-trimoxazole, and avoid Artesunate AND Amodiaquine if they are also receiving efavirenz or zidovudine.
  • 1.4.4 Large and Obese adults: For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.
  • 1.4.5 Patients co-infected with TB: Rifamycins, in particular rifampicin, are potent CYP3A4 inducers with weak antimalarial activity. Concomitant administration of rifampicin during quinine treatment of adults with malaria was associated with a significant decrease in exposure to quinine and a five-fold higher recrudescence rate
  • 1.4.6 Non-immune travellers : Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.
  • 1.4.7 Uncomplicated hyperparasitaemia: People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT.
  • 2. Treatment of uncomplicated malaria caused by P. vivax, P. ovale, P. malariae or P. knowlesi
  • 2.1 Blood Stage infection
  • 2.1.1. Uncomplicated malaria caused by P. vivax
  • 2.1.1.1 In areas with chloroquine-sensitive P. vivax
  • Preferred regimen: Chloroquine total dose of 25 mg/kg PO. Chloroquine is given at an initial dose of 10 mg/kg, followed by 10 mg/kg on the second day and 5 mg/kg on the third day.
  • 2.1.1.2 In areas with chloroquine-resistant P. vivax
  • 2.1.2 Uncomplicated malaria caused by P. ovale, P. malariae or P. knowlesi malaria
  • Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to chloroquine. In only one study, conducted in Indonesia, was resistance to chloroquine reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or Chloroquine, as for vivax malaria.
  • 2.1.3 Mixed malaria infections
  • Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.
  • 2.2 Liver stages (hypnozoites) of P. vivax and P. ovale
  • Note: To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of primaquine in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.]
  • 2.2.1 Primaquine for preventive relapse
  • Preferred regimen: Primaquine 0.25–0.5 mg/kg/day PO qd for 14 days
  • 2.2.2 Primaquine and glucose-6-phosphate dehydrogenase deficiency
  • Preferred regimen: Primaquine 0.75 mg base/kg/day PO once a week for 8 weeks.
  • Note: The decision to give or withhold Primaquine should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.
  • 2.2.3 Prevention of relapse in pregnant or lacating women and infants
  • Note: Primaquine is contraindicated in pregnant women, infants < 6 months of age and in lactating women (unless the infant is known not to be G6PD deficient).
  • 3. Treatment of severe malaria
  • 3.1 Treatment of severe falciparum infection with Artesunate
  • 3.1.1 Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women):-
  • Preferred regimen: Artesunate IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of an ACT (add single dose Primaquine in areas of low transmission).
  • 3.1.2 Young children weighing < 20 kg
  • Preferred regimen: Artesunate 3 mg/kg per dose IV/IM q24h
  • Alternatives regimen: use Artemether in preference to quinine for treating children and adults with severe malaria
  • 3.2.Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)
  • 3.2.1 Adults and children
  • 3.2.2 Children < 6 years
  • Preferred regimen: Where intramuscular injections of artesunate are not available, treat with a single rectal dose (10 mg/kg) of Artesunate, and refer immediately to an appropriate facility for further care.
  • Note: Do not use rectal artesunate in older children and adults.
  • 3.3 Pregancy
  • Note: Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed.
  • 3.4 Treatment of severe P. Vivax infection
  • Note: parenteral artesunate, treatment can be completed with a full treatment course of oral ACT or chloroquine (in countries where chloroquine is the treatment of choice). A full course of radical treatment with primaquine should be given after recovery.
  • 3.5 Additional aspects of management in severe malaria
  • Fluid therapy: It is not possible to give general recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit.
  • Blood Transfusion :In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended.
  • Exchange blood transfusion: Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion.

Bartonella

  • 1. Bartonella quintana
  • 1.1 Acute or chronic infections without endocarditis
  • Preferred regimen: Doxycycline 200 mg PO qd or 100 mg bid for 4 weeks PLUS Gentamicin 3 mg/kg IV q24h for the first 2 weeks[9]
  • 1.2 Endocarditis
  • 2. Bartonella elizabethae
  • 2.2 Endocarditis
  • 3. Bartonella bacilliformis
  • 3.1 Oroya fever
  • Preferred regimen: Ciprofloxacin 500 mg PO bid for 14 days
  • Note: if severe disease, associate Ceftriaxone 1 g IV q24h for 14 days
  • 3.2 Verruga peruana[11]
  • Preferred regimen: Azithromycin 500 mg PO qd for 7 days
  • Alternative regimen (1): Rifampin 600 mg PO qd for 14-21 days
  • Alternative regimen (2): Ciprofloxacin 500 mg bid for 7-10 days
  • 4. Bartonella hansealae
  • 4.1 Cat scratch disease
  • If extensive adenopathy[12]
  • Preferred regimen: Azithromycin 500 mg PO at day 1 THEN 250 mg PO for 4 days for patients weighting less than 45kg, 1 g PO at day 1 THEN 500 mg PO for 4 days for patients weighting more than 45 kg
  • Alternative regimen (1): Clarithromycin 500 mg PO bid
  • Note: Pediatric dose: 15-20 mg/kg/day PO bid (maximum dose 500 mg bid)
  • Alternative regimen (2): Rifampin 300 mg PO bid
  • Note Pediatric dose: Rifampin 10 mg/kg bid (maximum dose 600 mg daily)
  • Alternative regimen (3): Ciprofloxacin 500 mg PO bid for patients >17 years of age for 7-10 days
  • Alternative regimen (4): Trimethoprim-sulfamethoxazole one double strength tablet bid for 7-10 days
  • Note: Pediatric dose: trimethoprim 8 mg/kg per day, sulfamethoxazole 40 mg/kg per day bid for 7-10 days
  • 4.2 Endocarditis
  • 4.3 Retinitis
  • 4.4 Bacillary angiomatosis[13]
  • Preferred regimen (1): Erythromycin 500 mg PO qid for 2 months at least
  • Preferred regimen (2): Doxycycline 100mg PO bid for 2 months at least
  • 4.5 Bacillary Pelliosis[13]
  • Preferred regimen (1): Erythromycin 500 mg PO qid for 4 months at least
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months at least

Blastomycosis

  • 1. Mild to moderate pulmonary blastomycosis
  • Preferred regimen: Itraconazole 200 mg PO qd or bid for 6–12 months
  • Note: Oral Itraconazole, 200 mg tid PO for 3 days and THEN 200 mg PO qd or bid for 6–12 months
  • 2. Moderately severe to severe pulmonary blastomycosis
  • Preferred regimen (1): Lipid Amphotericin B 3–5 mg/kg IV q24h for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Preferred regimen (2): Amphotericin B deoxycholate 0.7–1 mg/kg IV q24h for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Note: Oral Itraconazole, 200 mg tid PO for 3 days THEN 200 mg PO bid, for a total of 6–12 months
  • 3. Mild to moderate disseminated blastomycosis
  • Preferred regimen: Itraconazole 200 mg PO qd or bid for 6–12 months
  • Note (1): Treat osteoarticular disease for 12 months
  • Note (2): Oral Itraconazole, 200 mg PO tid for 3 days THEN 200 mg PO bid, for 6–12 months
  • 4. Moderately severe to severe disseminated blastomycosis
  • Preferred regimen (1): Lipid Amphotericin B 3–5 mg/kg IV q24h, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Preferred regimen (2): Amphotericin B deoxycholate 0.7–1 mg/kg IV q24h, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Note: oral Itraconazole, 200 mg PO tid for 3 days THEN 200 mg PO bid, for 6–12 months
  • 5. CNS disease
  • Preferred regimen: Lipid Amphotericin B 5 mg/kg IV q24h for 4–6 weeks AND an oral azole for at least 1 year
  • Note (1): Step-down therapy can be with Fluconazole, 800 mg/day PO qd or bid OR Itraconazole, 200 mg bid or tid OR voriconazole, 200–400 mg bid.
  • Note (2): Longer treatment may be required for immunosuppressed patients.
  • 6. Immunosuppressed patients
  • Preferred regimen (1): Lipid Amphotericin B 3–5 mg/kg IV q24h, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
  • Preferred regimen (2): Amphotericin B deoxycholate, 0.7–1 mg/kg IV q24h, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
  • Note (1): Oral Itraconazole, 200 mg PO tid for 3 days THEN 200 mg PO bid, for 12 months
  • Note (2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.
  • 7. Pregnant women
  • Preferred regimen: Lipid Amphotericin B 3–5 mg/kg IV q24h
  • Note (1): Azoles should be avoided because of possible teratogenicity
  • Note (2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg IV q24h
  • 8. Children with mild to moderate disease
  • Preferred regimen: Itraconazole 10 mg/kg PO qd for 6–12 months
  • Note: Maximum dose 400 mg/day
  • 9. Children with moderately severe to severe disease
  • Preferred regimen (1): Amphotericin B deoxycholate 0.7–1 mg/kg IV q24h for 1–2 weeks AND Itraconazole 10 mg/kg PO qd to a maximum of 400 mg/day for 6–12 months
  • Preferred regimen (2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg IV q24h for 1–2 weeks AND Itraconazole 10 mg/kg PO qd to a maximum of 400 mg/day for 6–12 months
  • Note: Children tolerate Amphotericin B deoxycholate better than adults do.

Chromoblastomycosis

  • Preferred regimen: Itraconazole 200-400 mg PO q24h OR 400 mg pulse therapy once daily for 1 week monthly for 6-12 months
  • Note: Pulse therapy reduces cost but it is questionable if it produces resistance to the drug.
  • Alternative regimen (1): Terbinafine 500-1000 mg PO qd for 6-12 months
  • Alternative regimen (2): Posaconazole 800 mg PO qd for 6-12 months
  • Alternative regimen (3): 5-fluorocytosine 100-150 mg/kg/day PO qd for 6-12 months
  • Note: This disease has a low cure ratio and high relapse ratio. Physical treatment is needed to achieve better results:
  • Cryosurgery with liquid nitrogen - most used physical therapy, it's used in localized lesions and it has a very good treatment response, probably achieved by immune mechanisms since fungi are eliminated from lesions as late as 1-2 weeks after the therapy.
  • Thermotherapy - used in conjunction with systemic therapy, was developed by Japanese authors and consists in placing "pocket warmers" in the lesions for 24h/day for some months, as the fungi is sensible to heat.
  • Laser vaporization - studied in Germany as an alternative therapy, reported to successfully treat relapsing lesions.

Hepatitis C

Chronic Hepatitis C

  • 1. Treatment regimens for chronic hepatitis C virus genotype 1[16]
  • 1.1. Treatment regimens for genotype 1a:
  • Preferred regimen (1): Ledipasvir 90 mg PO qd AND Sofosbuvir 400 mg PO qd for 12 weeks
  • Preferred regimen (2): Paritaprevir 150 mg PO qd AND Ritonavir 100 mg PO qd AND Ombitasvir 25 mg PO qd AND Dasabuvir 250 mg PO bid AND weight-based Ribavirin PO qd ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) OR 24 weeks (cirrhosis)
  • Preferred regimen (3): Sofosbuvir 400 mg PO qd AND Simeprevir 150 mg PO qd ± weight-based Ribavirin PO qd ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
  • Note: these regimens are recommended for treatment-naive patients with HCV genotype 1a infection.
  • 1.2. Treatment regimens for genotype 1b:
  • Preferred regimen (1): Ledipasvir 90 mg PO qd AND Sofosbuvir 400 mg PO qd for 12 weeks
  • Preferred regimen (2): Paritaprevir PO 150 mg qd AND Ritonavir 100 mg PO qd AND Ombitasvir 25 mg PO qd AND Dasabuvir 250 mg PO bid for 12 weeks. The addition of weight-based Ribavirin PO qd (1000 mg [<75kg] to 1200 mg [>75 kg]) is recommended in patients with cirrhosis
  • Preferred regimen (3): Sofosbuvir 400 mg PO qd AND Simeprevir 150 mg PO qd for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
  • Note: these regimens are recommended for treatment-naive patients with HCV genotype 1b infection.
  • 2. Treatment regimens for chronic hepatitis C virus genotype 2[17]
  • Preferred regimen: Sofosbuvir 400 mg PO qd AND weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
  • Note (1): This regimen are recommended for treatment-naive patients with HCV genotype 2 infection.
  • Note (2): Extending treatment to 16 weeks is recommended in patients with cirrhosis.
  • 3. Treatment regimens for chronic hepatitis C virus genotype 3[18]
  • Preferred regimen: Sofosbuvir 400 mg PO qd and weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) PO qd for 24 weeks
  • Alternative regimen: Sofosbuvir 400 mg and weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) PO qd AND weekly PEG-IFN for 12 weeks is an acceptable regimen for IFN-eligible, treatment-naive patients with HCV genotype 3 infection.
  • Note: These regimens are recommended for treatment-naive patients with HCV genotype 3 infection.
  • 4. Treatment regimens for chronic hepatitis C virus genotype 4
  • Preferred regimen (1): Ledipasvir 90 mg PO qd AND Sofosbuvir 400 mg PO qd for 12 weeks
  • Preferred regimen (2): Paritaprevir 150 mg PO qd AND Ritonavir 100 mg PO qd AND Ombitasvir 25 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
  • Preferred regimen (3): Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks
  • Alternative regimen (1): Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) AND weekly PEG-IFN for 12 weeks
  • Alternative regimen (2): Sofosbuvir 400 mg PO qd AND Simeprevir 150 mg PO qd ± weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
  • Note: These regimens are accpetable for treatment-naive patients with HCV genotype 3 infection.
  • 5. Treatment regimens for chronic hepatitis C virus genotype 5[19]
  • Preferred regimen: Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd(1000 mg [<75 kg] to 1200 mg [>75 kg]) AND weekly PEG-IFN for 12 weeks is recommended for treatment-naive patients with HCV genotype 5 infection.
  • Alternative regimen: Weekly PEG-IFN AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 48 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 5 infection.
  • 6. Treatment regimens for chronic hepatitis C virus genotype 6[20]
  • Preferred regimen: Ledipasvir 90 mg PO qd AND Sofosbuvir PO qd 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 6 infection.
  • Alternative regimen: Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) AND weekly PEG-IFN for 12 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 6 infection.

Toxocariasis

  • 1.1.Visceral toxocariasis[21]
  • Preferred regimen: Albendazole 400 mg PO bid for five days (both adult and pediatric dosage)
  • Alternative regimen: Mebendazole 100-200 mg PO bid for five days (both adult and pediatric dosage)
  • Note: Treatment is indicated for moderate-severe cases. Patients with mild symptoms of toxocariasis may not require anthelminthic therapy as symptoms are limited.
  • 1.2.Ocular toxocariasis[22]
  • Preferred regimen: Prednisone 0.5-1 mg/kg/day PO q24h AND Albendazole 400 mg PO bid for 2 to 4 weeks (pediatric dose: 400 mg PO qd)[23]
  • Note: Surgical therapy might be neeeded.

Hep B

  • Chronic Hepatitis B
  • 1. Patients with HBeAg-positive chronic hepatitis B[24]
  • 1.1. HBV DNA >20,000, ALT <2 times upper limit normal (ULN)[24]
  • Observe; consider treatment when ALT becomes elevated.
  • Consider biopsy in persons 40 years, ALT persistently high normal >2 times upper limit normal (ULN), or with family history of HCC.
  • Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.
  • 1.2. HBV DNA >20,000, ALT >2 times upper limit normal (ULN)[24]
  • Preferred regimen (1): Pegylated IFN-alpha 180 mcg weekly SC for 48 weeks
  • Preferred regimen (2): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
  • If creatinine clearance 30–49 give 300 mg q48 hrs
  • If creatinine clearance 10–29 give 300 mg q72-96 hrs
  • If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
  • If creatinine clearance <10 without dialysis there is no recommendation
  • Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
  • Preferred regimen (3): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
  • If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
  • If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
  • If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
  • Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
  • Alternative regimen (1): Interferon alpha (IFNα) 5 MU daily or 10 MU thrice weekly SC for 16 weeks
  • Alternative regimen (2): Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 100 mg PO qd
  • If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
  • If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
  • If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
  • If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
  • The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
  • Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
  • Alternative regimen (3): Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 10 mg PO daily
  • If creatinine clearance 30–49 give 10 mg PO every other day
  • If creatinine clearance 10–19 10 mg PO every third day
  • If hemodialysis patients give 10 mg PO every week following dialysis
  • Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
  • Alternative regimen (4): Telbivudine (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 600 mg PO once daily
  • If creatinine clearance 30–49 600 give mg PO once every 48 hours
  • If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
  • If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
  • Note (1): duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
  • Note (2): Observe for 3-6 months and treat if no spontaneous HBeAg loss.
  • Note (3): Consider liver biopsy prior to treatment if compensated.
  • Note (4): Immediate treatment if icteric or clinical decompensation.
  • Note (5): Interferon alpha (IFNα)/ pegylated interferon-alpha (peg-IFNα), Lamivudine (LAM), Adefovir (ADV), Entecavir (ETV), tenofovir disoproxil fumarate (TDF) or telbivudine (LdT) may be used as initial therapy.
  • Note (6): Adefovir (ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
  • Note (7): Lamivudine (LAM) and Telbivudine (LdT) not preferred due to high rate of drug resistance.
  • Note (8): End-point of treatment – Seroconversion from HBeAg to anti-HBe.
  • Note (9): Interferon alpha (IFNα) non-responders / contraindications to IFNα change to Tenofovir (TDF)/Entecavir (ETV).
  • 1.3. Children with elevated ALT greater than 2 times normal[24]
  • Preferred regimen(1): Interferon alpha (IFNα) 6 MU/m2 SC thrice weekly with a maximum of 10 MU
  • Preferred regimen(2): Lamivudine (LAM) 3 mg/kg/d PO with a maximum of 100 mg/d.
  • 2. Patients with HBeAg-negative chronic hepatitis B[24]
  • 2.1. HBV DNA >2,000 IU/mL and elevated ALT >2 times normal
  • Preferred regimen (1): Pegylated IFN-alpha 180 mcg weekly SC for 1 year
  • Preferred regimen (2): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
  • If creatinine clearance 30–49 give 300 mg q48 hrs
  • If creatinine clearance 10–29 give 300 mg q72-96 hrs
  • If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
  • If creatinine clearance <10 without dialysis there is no recommendation
  • Note: duration of treatment is more than 1 year
  • Preferred regimen (3): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine
  • If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine
  • If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine
  • If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
  • Note: duration of treatment is more than 1 year
  • Alternative regimen (1): Interferon alpha (IFNα) 5 MU daily or 10 MU thrice weekly SC for 1 year
  • Alternative regimen (2): Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 100 mg PO qd
  • If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
  • If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
  • If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
  • If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
  • The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
  • Note: duration of treatment is more than 1 year
  • Alternative regimen (3): Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 10 mg PO daily
  • If creatinine clearance 30–49 give 10 mg PO every other day
  • If creatinine clearance 10–19 10 mg PO every third day
  • If hemodialysis patients give 10 mg PO every week following dialysis
  • Note: duration of treatment is more than 1 year
  • Alternative regimen (4): Telbivudine (LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 600 mg PO once daily
  • If creatinine clearance 30–49 600 give mg PO once every 48 hours
  • If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
  • If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
  • Note (1): duration of treatment is more than 1 year
  • Note (2): Interferon alpha (IFNα)/ pegylated interferon-alpha (peg-IFNα), Lamivudine (LAM), Adefovir (ADV), Entecavir (ETV), tenofovir disoproxil fumarate (TDF) or telbivudine (LdT) may be used as initial therapy.
  • Note (3): Adefovir (ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
  • Note (4): Lamivudine (LAM) and Telbivudine (LdT) not preferred due to high rate of drug resistance.
  • Note (5): End-point of treatment – not defined
  • Note (6): Interferon alpha (IFNα) non-responders / contraindications to IFNα change to Tenofovir (TDF)/Entecavir (ETV).
  • 3. HBV DNA >2,000 IU/mL and elevated ALT 1->2 times normal[24]
  • Consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.
  • 4. HBV DNA <2,000 IU/mL and ALT < upper limit normal (ULN)[24]
  • Observe, treat if HBV DNA or ALT becomes higher.
  • 5. +/- HBeAg and detectable HBV DNA with Cirrhosis[24]
  • 5.1. Compensated Cirrhosis and HBV DNA >2,000
  • Preferred regimen (1): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
  • If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
  • If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
  • If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
  • Preferred regimen (2): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
  • If creatinine clearance 30–49 give 300 mg q48 hrs
  • If creatinine clearance 10–29 give 300 mg q72-96 hrs
  • If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
  • If creatinine clearance <10 without dialysis there is no recommendation
  • Alternative regimen (1): Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 100 mg PO qd
  • If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
  • If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
  • If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
  • If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
  • The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
  • Alternative regimen (2): Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 10 mg PO daily
  • If creatinine clearance 30–49 give 10 mg PO every other day
  • If creatinine clearance 10–19 give 10 mg PO every third day
  • If hemodialysis patients give 10 mg PO every week following dialysis
  • Alternative regimen (3): Telbivudine (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 600 mg PO once daily
  • If creatinine clearance 30–49 600 give mg PO once every 48 hours
  • If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
  • If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
  • Note (1): LAM and LdT not preferred due to high rate of drug resistance.
  • Note (2): ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.
  • Note (3): These patients should receive long-term treatment. However, treatment may be stopped in HBeAg-positive patients if they have confirmed HBeAg seroconversion and have completed at least 6 months of consolidation therapy and in HBeAg-negative patients if they have confirmed HBsAg clearance.
  • 5.2. Compensated Cirrhosis and HBV DNA <2,000
  • Consider treatment if ALT elevated.
  • 5.3. Decompensated Cirrhosis
  • Preferred regimen (1): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
  • If creatinine clearance 30–49 give 300 mg q48 hrs
  • If creatinine clearance 10–29 give 300 mg q72-96 hrs
  • If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
  • If creatinine clearance <10 without dialysis there is no recommendation
  • Preferred regimen (2): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
  • If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
  • If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
  • If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
  • Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 100 mg PO qd
  • If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
  • If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
  • If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
  • If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
  • The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
  • Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 10 mg PO daily
  • If creatinine clearance 30–49 give 10 mg PO every other day
  • If creatinine clearance 10–19 give 10 mg PO every third day
  • If hemodialysis patients give 10 mg PO every week following dialysis
  • Telbivudine (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 600 mg PO once daily
  • If creatinine clearance 30–49 600 give mg PO once every 48 hours
  • If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
  • If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
  • Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
  • If creatinine clearance >50 or normal renal function give 10 mg PO daily
  • If creatinine clearance 30–49 give 10 mg PO every other day
  • If creatinine clearance 10–19 give 10 mg PO every third day
  • If hemodialysis patients give 10 mg PO every week following dialysis
  • Note: coordinate treatment with transplant center and refer for liver transplant.
  • Life-long treatment is recommended.
  • 6. +/- HBeAg and undetectable HBV DNA with Cirrhosis[24]
  • Compensated Cirrhosis: Observe
  • Uncompensated Cirrhosis: Refer for liver transplant

Schistosomiasis

  • 1. Schistosoma mansoni, S. haematobium, S. intercalatum[25]
  • Preferred regimen: Praziquantel 40 mg/kg per day PO in qd or bid for one day
  • Alternative regimen (1): Oxamniquine 20 mg/kg PO single dose[26][27]
  • Alternative regimen (2): Artemisinin no dose is established yet[25]
  • Alternative regimen (3): Mefloquine 250 mg PO single dose
  • Note: There is no benefit in associating the alternative therapies to Praziquantel.
  • Note: Praziquantel is not effective against larval/egg stages of the disease.[28]
  • 2. S. japonicum, S. mekongi[25]
  • Preferred regimen: Praziquantel 60 mg/kg per day PO bid for one day
  • Alternative regimen (1): Artemisinin no dose is established yet
  • Alternative regimen (2): Mefloquine 250 mg PO single dose
  • Note: There is no benefit in associating the alternative therapies to Praziquantel.
  • 3. Katayama Fever
  • Preferred regimen: Prednisone 20-40 mg/day PO for 5 days, THEN Praziquantel[29]
  • Note: Praziquantel should be used after 4-6 weeks of exposure, because it cannot kill the larvae stages of the Schistosoma. Praziquantel should be used after acute schistosomiasis syndrome symptoms have resolved always together with corticosteroids, only when ova are detected in stool or urine samples.[30]
  • 4. Neuroschistosomiasis
  • Preferred regimen: prednisone 1-2 mg/kg
  • Note: Praziquantel should only be introduced after a few days of the initiation of corticosteroid therapy, due to the risk of increasing the inflammatory response.

Parasites – Trematodes (Flukes)

  • Preferred regimen: Praziquantel 75 mg/kg/day PO tid for 2 days[31]
  • Alternative regimen (1): Albendazole 10 mg/kg/day PO qd for 7 days[32]
  • Alternative regimen (2): Tribendimidine 400 mg PO single dose[33]
  • Note: This regimen is still under investigation, but it appears to be as effective as Praziquantel.
  • Note: Urgent biliary decompression might be required for patients with acute cholangitis.
  • Note: Praziquantel is not approved for treatment of children less than 4 years old[35]
  • Alternative regimen (1): Myrrh (commiphora molmol) 12 mg/kg/day PO for 6 days[36]
  • Alternative regimen (2): Triclabendazole 10 mg/kg PO single dose[36]
  • Preferred regimen: Triclabendazole 10 mg/kg PO one dose[37]
  • Note: Two-dose (double-dose) triclabendazole therapy can be given to patients who have severe or heavy Fasciola infections (many parasites) or who did not respond to single-dose therapy.
  • Alternative regimen: Nitazoxanide 500 mg PO bid for 7 days
  • Preferred regimen (1): Praziquantel 25 mg/kg PO tid for 3 days[38]
  • Preferred regimen (2): Triclabendazole 10 mg/kg PO qd or bid
  • Alternative regimen (1): Bithinol 30-50 mg/kg PO on alternate days for 10-15 doses
  • Alternative regimen (2): Niclosamide 2 mg/kg PO single dose

Parasites – Intestinal Nematodes (Roundworms)

  • Eosinophilic Meningitis
    • Preferred regimen: Supportive measures. Anthelminthic therapy might be deleterious by augmenting the inflammation due to the death of the larvae. The use of corticosteroids is generally favored for suppression of the inflammation but there are no clinical trials that prove its efficacy.[39]
  • Cutaneous disease:
  • Preferred regimen[42]
  • Adult: Albendazole 400 mg PO qd for 3 to 7 days
  • Pediatric: Albendazole > 2 years 400 mg PO qd for 3 days
  • Note: This drug is contraindicated in children younger than 2 years age
  • Alternative regimen[43]
  • Adult: Ivermectin 200 mcg/kg PO qd for one or two days
  • Pediatric: Ivermectin >15 kg give 200 mcg/kg single dose
  • Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60 mg qd for 2 weeks) and analgesics.[44]
  • Note: Albendazole and Mebendazole are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.[45]
  • Note: Albendazole dose for children of 1-2 years is 200 mg instead of 400 mg.
  • Alternative regimen (1): Ivermectin 150 to 200 µg/kg PO single dose[47]
  • Alternative regimen (2): Nitazoxanide 500 mg bid for 3 days [48]
  • Alternative regimen (3): Levamisole 150 mg PO single dose
  • Note: Pediatric dose: 2.5 mg/kg single dose [49]
  • Alternative regimen (4): Pyrantel Pamoate 11 mg/kg single dose PO - maximum 1.0 g[49]
  • Alternative regimen (5): Piperazine citrate 75 mg/kg qd for 2 days - maximum 3.5 g[49]
  • Preferred regimen: Albendazole 400 mg/day PO for 10-30 days
  • Alternative regimen: Mebendazole 200 mg PO bid for 20-30 days
  • Preferred regimen (1): Albendazole 400 mg PO single dose - repeat in 2 weeks[53]
  • Preferred regimen (2): Mebendazole 100 mg PO single dose - repeat in 2 weeks
  • Alternative regimen (1): Ivermectin 200 µg/kg PO single dose - repeat in 10 days[54]
  • Alternative regimen (2): Pyrantel pamoate 11 mg/kg up to 1.0 g PO single dose - repeat in 2 weeks[55]
  • Preferred regimen: Albendazole 400 mg PO single dose[56]
  • Alternative regimen (1): Mebendazole 100 mg PO bid or 500 mg daily for 3 days
  • Alternative regimen (2): Pyrantel pamoate 11 mg/kg PO qd (maximum 1 g/day) for 3 days[57]
  • Preferred regimen: Albendazole 400 mg PO single dose[56]
  • Alternative regimen (1): Mebendazole 100 mg PO bid or 500 mg daily for 3 days
  • Alternative regimen (2): Pyrantel pamoate 11 mg/kg PO qd (maximum 1 g/day) for 3 days[58]
  • Preferred regimen: Ivermectin 200 mcg/kg/day PO qd for 2 days or two doses 2 weeks apart from each other[59]
  • Alternative regimen: Albendazole 400 mg PO bid for 3-7 days[60]
  • Preferred regimen: Albendazole 400 mg PO qd for 3 days
  • Alternatie regimen (1): Mebendazole 100 mg PO bid for 3 days
  • Alternative regimen (2): Ivermectin 200 mcg/kg/day PO qd for 3 days[61]

Entamoeba histolytica

  • 1. Amebic Liver Abscess[62]
  • 2. Amebic Colitis[63]
  • 3. Asymptomatic Intestinal Colonization[64]
  • Preferred regimen: Paromomycin 30 mg/kg/day PO tid for 5-10 days
  • Alternative regimen (1): Diloxanide furoate 500 mg PO tid for 10 days
  • Alternative regimen (2): Diiodohydroxyquin 650 mg PO tid for 20 days for adults and 30 to 40 mg/kg per day tid for 20 days for children

Paracoccidiodomycosis

  • Preferred regimen (1): [65]
  • 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): [65]
  • 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 q8h 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.[65]
  • Note: Preferred in severe forms of the disease.[65]
  • Alternative regimen (4): Ketoconazole 200-400 mg/day PO for 9-12 months[66]
  • Alternative regimen (5): Voriconazole initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months[67]
  • Note: Diminish the dose to 50% if weight is <40 kg.

Coccidioidomycosis

Candidiasis

Aspergillosis

  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • 2. Invasive sinus aspergillosis
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • 3. Tracheobronchial aspergillosis
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • 4. Chronic necrotizing pulmonary aspergillosis
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • 5. Aspergillosis of the CNS
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • Note: There are drug interactions with anticonvulsant therapy.
  • 6. Aspergillus infections of the heart (endocarditis, pericarditis, and myocarditis)
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • Note: endocardial lesions generally require surgical treatment. Aspergillus pericarditis usually requires pericardiectomy.
  • 7. Aspergillus osteomyelitis and septic arthritis
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • Note: Surgical resection of devitalized bone and cartilage is important for curative intent.
  • 8. Aspergillus infections of the eye (endophthalmitis and keratitis)
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • Note: Topical therapy is indicated for keratitis, ophthalmologic intervention and management is recommended for all forms of ocular infection. Systemic therapy may be beneficial when treating aspergillus endophthalmitis.
  • 9. Cutaneous aspergillosis
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • Note: Surgical resection is indicated when feasible.
  • 10. Aspergillus peritonitis
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • 11. Prophylaxis against invasive aspergillosis
  • 12. Aspergilloma
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen: Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • 13. Chronic cavitary pulmonary aspergillosis
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
  • Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV q24h
  • Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV q24h
  • Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
  • Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (6): Micafungin 100–150 mg/day PO qd[28][68]
  • Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
  • Note: long-term therapy might be needed.
  • 14. Allergic bronchopulmonary Itraconazole aspergillosis
  • Preferred regimen: Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Alternative regimen (1): Voriconazole PO 200 mg bid
  • Alternative regimen (2): Posaconazole PO 400 mg bid
  • Note: Corticosteroids are a cornerstone of the therapy.
  • 15. Allergic aspergillus sinusitis
  • Preferred regimen: None or Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV q24h
  • Note: Few data available for other agents.
  • 16. Relative indications for surgical treatment of invasive aspergillosis
  • Pulmonary lesion in proximity to great vessels or pericardium;
  • Pericardial infection;
  • Invasion of chest wall from contiguous pulmonary lesion;
  • Aspergillus empyema;
  • Persistent hemoptysis from a single cavitary lesion;
  • Infection of skin and soft tissues;
  • Infected vascular catheters and prosthetic devices;
  • Endocarditis;
  • Osteomyelitis;
  • Sinusitis;
  • Cerebral lesions.

Yellow Fever Virus

  • 1.1. Summary
  • Yellow fever was one of the most lethal diseases before the development of the vaccine. It is a major health concern for unvaccinated travellers to tropical regions in South America and Africa. It is transmitted by mosquitoes (Aedes aegypti) bites in a cycle which involve these mosquitoes biting also monkeys and human beings, which act as hosts for the virus. The yellow fever virus is a member of the Flaviviridae family, which comprises about 70 viruses, most of which are arthropod-borne.
  • 1.2. Epidemiology
  • Up to 5000 cases are reported annually in Africa and 300 annually in South America, although it is believed that numbers are underestimated. In Africa the human population is seasonally exposed in and around villages and small cities so the highest risk of disease are children without naturally acquired immunity. In South America the virus is transmitted in poorly populated forested areas and it occurs mainly with workers and farmers in the borders of the forested areas.
  • 1.3. Clinical Manifestations
  • Yellow fever can present itself in three forms: subclinical infection, nonspecific abortive febrile disease and fatal hemorrhagic fever. The incubation time for the disease is 3-6 days. After this period, the onset of fever, myalgia, lower back pain, irritability, nausea, malaise, headache, fotofobia and dizziness is oftenly abrupt. These findings are not specific to Yellow Fever and can be found in any acute infection. During this period the patient can be a source of virus for mosquitoes.
  • On physical examination the liver can be enlarged with tenderness, Faget sign (slow pulse rate despite high fever) can be found. Skin might appear flushed with reddening of conjunctivae and gums. Between 48-72h after onset and before the jaundice, hepatic enzymes starts to rise. Laboratory studies may show leukopenia with relative neutropenia. This is called period of infection and may last for several days and may be THEN a remission period which last about 48h, with the disappearance of the fever and the symptoms. Patients with the abortive form of the disease recover at this stage.
  • After the third to sixth day of the onset of the symptoms the patient may present return of the fever, vomiting, renal failure (oliguria), jaundice, epigastric pain and hemorrhagic diathesis. The viremia terminates during this stage and the antibodies appear in the blood. The patient may evolve with multiorgan failure during this phase. Also in this stage, AST concentrations might exceed ALT, probably due to myocardial and skeletal muscle damage. Serum creatinine and bilirubin levels also rise at this stage. Hemorrhagic manifestations may include petechiae, ecchymoses, epistaxis, melena, metrorrhagia, haematemesis. Laboratory studies may show thrombocytopenia, reduced fibrinogen levels, presence of fibrin split products, reduced factors II, V, VII, VIII, IX and X, which suggest a multifactorial cause for the bleeding with a consumption coagulopathy. Myocardial disfunction may be demonstrated by abnormalities in the ST-T segment in the electrocardiogram. Encephalitis is very rare.
  • 20-50% of the patients with the hepatorenal disease die after 7-10 days of the onset.
  • 1.4. Diagnosis
  • Diagnosis can be made by serology, detection of viral genome by polymerase chain reaction, immunohistochemistry on postmortem tissues, viral isolation or histopathology. No commercial test is available and diagnostic capabilities are restricted to selected laboratories only. Serologic diagnosis is made by dosing IgM antibodies with ELISA. The virus might be isolated by inoculating it in mice, cell cultures or mosquitoes. PCR is generally used to detect viral genome in clinical samples that were negative by virus isolation or other method.
  • 1.5. Treatment
  • Preferred regimen: No specific treatment is available for yellow fever. In the toxic phase, supportive treatment includes therapies for treating dehydration and fever. Ribavirin has failed in several studies in the monkey model.
  • Note: An international seminar held by WHO in 1984 recommended maintenance of nutrition, prevention of hypoglycemia, maintenance of the blood pressure with fluids and vasoactive drugs, prevention of bleeding with fresh-frozen plasma, dialysis if renal failure, correction of metabolic acidosis, administration of cimetidine IV to avoid gastric bleeding and oxygen if needed.
  • 1.6. Prevention
  • The Yellow fever 17D is highly effective, safe, attenuated vaccine that has been used for over 60 years. It should be taken my travellers who are going to endemic areas of the disease. Revaccination is needed after 10 years from the first dose. The side effects of the vaccines are rare but they include yellow fever associated viscerotropic disease and neurotropic disease. Immunization is contraindicated during pregnancy and in patients with immunodeficiency due to cancers, HIV/AIDS, or treatment with immunosuppressive agents.

Chikungunya Fever

Chikungunya Fever [71]
  • Preferred regimen: no specific therapeutics agents are available and there are no licensed vaccines to prevent Chikungunya Fever.
  • Note: Anti inflammatory drugs can be used to control joint swelling and arthritis.

Rabies

  • Rabies
  • Preferred regimen: no specific therapeutics agents are available once the disease is established.
  • Note: There are vaccines and immune globulins available for postexposure prophylaxis:
  • Postexposure Prophylaxis for non immunized individuals: Wound cleansing, human rabies immune globulin - administer full dose infiltrated around any wound. Administer any remaining volume IM at other site anatomically distant from the wound. Administer vaccine 1,0ml, IM at deltoid area one each on days 0, 3, 7 and 14.
  • Postexposure Prophylaxis for immunized individuals: Wound cleansing, do not administer human rabies immune globulin. Administer vaccine 1,0ml, IM at deltoid area one each on days 0 and 3.

Cryptococcus

  • 1. Cryptococcus neoformans
  • 1.1 Cryptococcus neoformans meningitis in HIV infected patients[72]
  • Preferred regimen for induction and consolidation: (Amphotericin B deoxycholate 0.7-1.0 mg/kg IV q24h OR Liposomal AmB 3-4 mg/kg IV q24h OR Amphotericin B lipid complex 5 mg/kg IV q24h) AND Flucytosine 100 mg/kg/day PO/IV q6h for at least 2 weeks THEN Fluconazole 400 mg (6 mg/kg) PO qd for at least 8 weeks
  • Alternative regimen for induction and consolidation (1): Amphotericin B deoxycholate 0.7-1.0 mg/kg IV q24h OR Liposomal AmB 3-4 mg/kg IV q24h OR AmB lipid complex 5 mg/kg IV q24h for 4-6 weeks
  • Alternative regimen for induction and consolidation (2): Amphotericin B deoxycholate 0.7 mg/kg IV q24h AND Fluconazole 800 mg PO qd for 2 weeks, THEN Fluconazole 800 mg PO qd for at least 8 weeks
  • Alternative regimen for induction and consolidation (3): Fluconazole 800-1200 mg PO qd AND Flucytosine 100 mg/kg/day PO qid for 6 weeks
  • Alternative regimen for induction and consolidation (4): Fluconazole PO 800-2000 mg qd for 10-12 weeks
  • Preferred regimen for maintenance and prophylactic therapy: Initiate HAART 2-10 weeks after commencing initial antifungal therapy AND Fluconazole 200 mg PO qd
  • Alternative regimen for maintenance and prophylactic therapy: Itraconazole 200 mg PO bid - monitor drug-level (trough concentration must be higher than 0.5 μg/ml) OR Amphotericin B deoxycholate 1 mg/kg per week IV (should be used in azole-intolerant patients)
  • Note (1): Consider discontinuing supressive therapy if CD4 count is higher than 100 cells/uL AND undetectable OR very low HIV RNA level for more than 3 months. Consider reinstitution of maintenance therapy if CD4 count <100 cels/uL.
  • Note (2): Do not use acetazolamide OR mannitol OR corticosteroids to treat increased intracranial pressure, instead it should be used lombar puncture in the absence of focal neurologic signs or impaired mentation (which, if present, patient must be submitted to CT or MRI scan first).
1.2. Cerebral cryptococcomas
  • Preferred regimen for induction and consolidation: (Amphotericin B deoxycholate 0.7-1.0 mg/kg IV q24h OR Liposomal AmB 3-4 mg/kg IV q24h OR Amphotericin B lipid complex 5 mg/kg IV q24h) AND Flucytosine 100 mg/kg/day PO/IV q6h for at least 2 weeks THEN Fluconazole 400 mg (6 mg/kg) PO qd for at least 8 weeks
  • Note: Consider surgery if lesions are larger than 3 cm, accessible lesions with mass effect or lesions that are enlarging and not explained by IRIS.
1.3. Cryptococcus neoformans meningitis in HIV negative patients
  • Preferred regimen: Amphotericin B deoxycholate 0.7-1.0 mg/kg IV q24h AND Flucytosine 100 mg/kg/day PO or IV q6h for at least 4 weeks (which may be extended to 6 weeks if there is any neurological complication) THEN Fluconazole 400 mg PO qd for 8 weeks.
  • Note (1): If there's toxicity to Amphotericin B deoxycholate, consider changing to Liposomal AmB or Amphotericin B lipid complex in the second 2 weeks.
  • Note (2): After induction and consolidation therapy, start Fluconazole 200 mg (3 mg/kg) PO qd for 6-12 months.
  • Note (3): If Flucytosine is not given, consider lengthening the induction therapy for at least 2 weeks.
1.4. Cryptococcus neoformans pulmonary disease - immunosupressed
  • Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:
  • Preferred regimen: Fluconazole 400 mg PO qd for 6-12 months
  • Severe pneumonia or disseminated disease or CNS infection:
  • Preferred regimen: treat like CNS cryptococcosis.
  • Note (1): In HIV- infected patients, treatment should be stopped after 1 year if CD4 count is >100 and a cryptococcal antigen titer is <1:512 and not increasing.
  • Note (2): Consider corticosteroid if ARDS is present in a context which it might be attributed to IRIS.
1.5 Cryptococcus neoformans pulmonary disease - non-immunosupressed
  • Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:
  • If there's severe pneumonia, disseminated disease or CNS infection:
  • Preferred regimen: treat like CNS cryptococcosis for 6-12 months.
1.6 Cryptococcus neoformans non-lung, non-CNS infection
  • Cryptococcemia or disseminated cryptococcic disease (involvement of at least 2 noncontiguous sites or cryptococcal antigen titer >1:512):
  • Preferred regimen: treat like CNS infection.
  • If infection occurs at a single site and no immunosupressive risk factors
  • Preferred regimen: Fluconazole 400 mg PO qd for 6-12 months
1.7. Cryptococcosis in Children
  • Preferred regimen for induction and consolidation: Amphotericin B deoxycholate 1.0 mg/kg qd IV AND Flucytosine 100 mg/kg PO or IV q6h for 2 weeks THEN Fluconazole 10-12 mg/kg PO qd for 8 weeks
  • Alternative regimen: patients with renal dysfunction: change Amphotericin B deoxycholate by Liposomal AmB 5 mg/kg IV q24h or Amphotericin B lipid complex (ABLC) 5 mg/kg IV q24h
  • Preferred regimen for maintenance: Fluconazole 6 mg/kg PO qd. Discontinuation of maintenance therapy is poorly studied and should be individualized.
  • Cryptococcal pneumonia:
  • Preferred regimen Fluconazole 6-12 mg/kg PO qd for 6-12 months
1.8. Cryptococcosis in Pregnant Women
  • Preferred regimen for induction and consolidation: Amphotericin B deoxycholate 0.7-1.0 mg/kg IV q24h. Start Fluconazole after delivery. Avoid use during first trimester and consider use in the last 2 trimesters with the need for continuous antifungal therapy during pregnancy.
  • Note (1): Consider using lipid formulations for patients with renal dysfunction - Liposomal AmB 3-4 mg/kg IV q24h OR Amphotericin B lipid complex (ABLC) 5 mg/kg IV q24h.
  • Note (2): Consider using Flucytosine in relationship to benefit risk basis, since it is a Category C drug for pregnancy.
  • Note (3): If pulmonary cryptococcosis: perform close follow-up and administer fluconazole after delivery.
2. Cryptococcus gatti
  • Disseminated cryptococcosis or CNS disease:
  • Preferred regimen: treatment is the same as C. neoformans
  • Pulmonary disease: single and small cryptococcoma:
  • Preferred regimen: Fluconazole 400 mg per day PO for 6-18 months
  • Pulmonary disease: Very large or multiple cryptococcomas:
  • Preferred regimen: administer Flucytosine AND AmB deocycholate for 4-6 weeks, THEN Fluconazole for 6-18 months
  • Note: Surgery should be considered if there is compression of vital structures OR failure to reduce the size of the cryptococcoma after 4 weeks of therapy

Dermatophytosis

  • 1. Tinea Cruris
  • 2. Tinea Corporis
  • 2.1 Small, well-defined lesions:
  • 2.2 Larger lesions:
  • 3. Tinea Pedis
  • 4. Tinea Capitis
  • Preferred regimen: Griseofulvin 10-20 mg/kg/day PO qd for at least 6 weeks (Preferred for children).
  • Alternative regimens: Terbinafine 62.5 mg/day if <20kg; 125 mg/day if 20-40kg; 250 mg/day if >40kg PO qd for 8 weeks OR Itraconazole 4-6 mg/kg/day (maximum 400 mg) PO for 4-6 weeks
  • Note: Nistatin is not effective in the treatment of dermatophytosis.
  • 5. Tinea Barbae
  • Preferred regimen: Terbinafine 250 mg/day PO qd for 4 weeks
  • Alternative regimen: Itraconazole 200 mg/day PO qd for 2 weeks
  • 6. Tinea Incognito
  • Preferred regimen: Stop topical steroids and treat with topical 1% terbinafine cream for 6 weeks
  • 7. Tinea Manuum
  • Preferred regimen: topical or systemic terbinafine 250 mg/day PO qd por 2-4 weeks
  • 8.Tinea Versicolor
  • 9. Majocchi's Granuloma
  • Preferred regimen: Terbinafine 250 mg/day PO for 2-4 weeks or Itraconazole 200 mg PO bid for 1 week, per month for 2 months
  • 10. Onychomycosis[74]
  • 10.1 Fingernails
  • Preferred regimen: Terbinafine 250 mg/day PO for 6 weeks OR Itraconazole 200 mg PO bid for one week per month for 2 months (European guidelines)
  • 10.2 Toenails
  • Preferred regimen: Toenails Terbinafine 250 mg/day PO for 12 weeks OR Itraconazole 200 mg/day PO for 12 weeks (U.S. guidelines) OR Itraconazole 200 mg PO bid for one week per month for 3 months (European guidelines)
  • Note: There is no evidence that combining systemic and topic treatments has any benefit to the patient.

References

  1. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  2. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  3. ↑ Altemeier WA, Fullen WD (1971). "Prevention and treatment of gas gangrene". JAMA. 217 (6): 806–13. PMID 5109333.
  4. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  5. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  6. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  7. ↑ "Guidelines for the treatment of malaria. Third edition April 2015" (PDF).
  8. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  9. ↑ Foucault C, Raoult D, Brouqui P (2003). "Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia". Antimicrob Agents Chemother. 47 (7): 2204–7. PMC 161867. PMID 12821469.
  10. ↑ 10.0 10.1 Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
  11. ↑ Bradley JS, Jackson MA, Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011; 128:e1034.
  12. ↑ Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob Agents Chemother. 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMC 415619. PMID 15155180.
  13. ↑ 13.0 13.1 Spach DH, Koehler JE (1998). "Bartonella-associated infections". Infect Dis Clin North Am. 12 (1): 137–55. PMID 9494835.
  14. ↑ Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG; et al. (2008). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clin Infect Dis. 46 (12): 1801–12. doi:10.1086/588300. PMID 18462107.
  15. ↑ Krzyściak PM, Pindycka-Piaszczyńska M, Piaszczyński M (2014). "Chromoblastomycosis". Postepy Dermatol Alergol. 31 (5): 310–21. doi:10.5114/pdia.2014.40949. PMC 4221348. PMID 25395928.
  16. ↑ "INITIAL TREATMENT OF HCV INFECTION".
  17. ↑ "INITIAL TREATMENT OF HCV INFECTION".
  18. ↑ "INITIAL TREATMENT OF HCV INFECTION".
  19. ↑ "INITIAL TREATMENT OF HCV INFECTION".
  20. ↑ "INITIAL TREATMENT OF HCV INFECTION".
  21. ↑ "Parasites - Toxocariasis".
  22. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  23. ↑ Barisani-Asenbauer T, Maca SM, Hauff W, Kaminski SL, Domanovits H, Theyer I; et al. (2001). "Treatment of ocular toxocariasis with albendazole". J Ocul Pharmacol Ther. 17 (3): 287–94. doi:10.1089/108076801750295317. PMID 11436948.
  24. ↑ 24.0 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 Lok AS, McMahon BJ (2009). "Chronic hepatitis B: update 2009". Hepatology. 50 (3): 661–2. doi:10.1002/hep.23190. PMID 19714720.
  25. ↑ 25.0 25.1 25.2 Colley DG, Bustinduy AL, Secor WE, King CH (2014). "Human schistosomiasis". Lancet. 383 (9936): 2253–64. doi:10.1016/S0140-6736(13)61949-2. PMID 24698483.
  26. ↑ National Center for Biotechnology Information. PubChem Compound Database; CID=4612, https://pubchem.ncbi.nlm.nih.gov/compound/4612 (accessed July 16, 2015).
  27. ↑ BINA, J. C. and PRATA, A.. Tratamento da esquistossomose com oxamniquine (xarope) em crianças. Rev. Soc. Bras. Med. Trop.[online]. 1975, vol.9, n.4 [cited 2015-07-16], pp. 175-178 . Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86821975000400002&lng=en&nrm=iso>. ISSN 0037-8682. http://dx.doi.org/10.1590/S0037-86821975000400002.
  28. ↑ 28.00 28.01 28.02 28.03 28.04 28.05 28.06 28.07 28.08 28.09 28.10 28.11 Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G (2014). "Invasive fungal infections in the ICU: how to approach, how to treat". Molecules. 19 (1): 1085–119. doi:10.3390/molecules19011085. PMID 24445340.
  29. ↑ Jauréguiberry S, Paris L, Caumes E (2010). "Acute schistosomiasis, a diagnostic and therapeutic challenge". Clin Microbiol Infect. 16 (3): 225–31. doi:10.1111/j.1469-0691.2009.03131.x. PMID 20222897.
  30. ↑ Jauréguiberry S, Paris L, Caumes E (2009). "Difficulties in the diagnosis and treatment of acute schistosomiasis". Clin Infect Dis. 48 (8): 1163–4, author reply 1164-5. doi:10.1086/597497. PMID 19292640.
  31. ↑ "Clonorchis".
  32. ↑ "Clonorchis".
  33. ↑ Qian MB, Yap P, Yang YC, Liang H, Jiang ZH, Li W; et al. (2013). "Efficacy and safety of tribendimidine against Clonorchis sinensis". Clin Infect Dis. 56 (7): e76–82. doi:10.1093/cid/cis1011. PMC 3588115. PMID 23223597.
  34. ↑ "Dicrocoeliasis".
  35. ↑ "Dicrocoeliasis".
  36. ↑ 36.0 36.1 Rana SS, Bhasin DK, Nanda M, Singh K (2007). "Parasitic infestations of the biliary tract". Curr Gastroenterol Rep. 9 (2): 156–64. PMID 17418062.
  37. ↑ "Parasites - Fascioliasis".
  38. ↑ "Parasites - Paragonimiasis".
  39. ↑ Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J; et al. (2009). "Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species". Clin Infect Dis. 48 (3): 322–7. doi:10.1086/595852. PMID 19123863.
  40. ↑ "Gnathostomiasis".
  41. ↑ "Gnathostomiasis".
  42. ↑ "Parasites - Zoonotic Hookworm".
  43. ↑ "Parasites - Zoonotic Hookworm".
  44. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  45. ↑ Chotmongkol V, Kittimongkolma S, Niwattayakul K, Intapan PM, Thavornpitak Y (2009). "Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis". Am J Trop Med Hyg. 81 (3): 443–5. PMID 19706911.
  46. ↑ "Parasites - Ascariasis".
  47. ↑ "Parasites - Ascariasis".
  48. ↑ Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A (1997). "Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico". Trans R Soc Trop Med Hyg. 91 (6): 701–3. PMID 9580117.
  49. ↑ 49.0 49.1 49.2 Khuroo MS (1996). "Ascariasis". Gastroenterol Clin North Am. 25 (3): 553–77. PMID 8863040.
  50. ↑ Cross, J. H. (1992-04). "Intestinal capillariasis". Clinical Microbiology Reviews. 5 (2): 120–129. ISSN 0893-8512. PMC 358231. PMID 1576584. Check date values in: |date= (help)
  51. ↑ Attia, Rasha A. H.; Tolba, Mohammed E. M.; Yones, Doaa A.; Bakir, Hanaa Y.; Eldeek, Hanan E. M.; Kamel, Shereef (2012-01). "Capillaria philippinensis in Upper Egypt: has it become endemic?". The American Journal of Tropical Medicine and Hygiene. 86 (1): 126–133. doi:10.4269/ajtmh.2012.11-0321. ISSN 1476-1645. PMC 3247121. PMID 22232463. Check date values in: |date= (help)
  52. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  53. ↑ Wang BR, Wang HC, Li LW, Zhang XL, Yue JQ, Wang GX; et al. (1987). "Comparative efficacy of thienpydin, pyrantel pamoate, mebendazole and albendazole in treating ascariasis and enterobiasis". Chin Med J (Engl). 100 (11): 928–30. PMID 3130234.
  54. ↑ Heukelbach J, Wilcke T, Winter B, Sales de Oliveira FA, Sabóia Moura RC, Harms G; et al. (2004). "Efficacy of ivermectin in a patient population concomitantly infected with intestinal helminths and ectoparasites". Arzneimittelforschung. 54 (7): 416–21. doi:10.1055/s-0031-1296993. PMID 15344847.
  55. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  56. ↑ 56.0 56.1 Keiser J, Utzinger J (2008). "Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis". JAMA. 299 (16): 1937–48. doi:10.1001/jama.299.16.1937. PMID 18430913.
  57. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  58. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  59. ↑ "WGO Practice Guideline Management of Strongyloidiasis" (PDF).
  60. ↑ Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR (1993). "Albendazole is effective treatment for chronic strongyloidiasis". Q J Med. 86 (3): 191–5. PMID 8483992.
  61. ↑ "Parasites - Trichuriasis".
  62. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  63. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  64. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  65. ↑ 65.0 65.1 65.2 65.3 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.
  66. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  67. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  68. ↑ 68.00 68.01 68.02 68.03 68.04 68.05 68.06 68.07 68.08 68.09 68.10 68.11 Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA; et al. (2008). "Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America". Clin Infect Dis. 46 (3): 327–60. doi:10.1086/525258. PMID 18177225.
  69. ↑ "District guidelines for yellow fever surveillance" (PDF).
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  71. ↑ Weaver SC, Lecuit M (2015). "Chikungunya virus and the global spread of a mosquito-borne disease". N Engl J Med. 372 (13): 1231–9. doi:10.1056/NEJMra1406035. PMID 25806915.
  72. ↑ Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ; et al. (2010). "Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america". Clin Infect Dis. 50 (3): 291–322. doi:10.1086/649858. PMID 20047480.
  73. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  74. ↑ de Berker D (2009). "Clinical practice. Fungal nail disease". N Engl J Med. 360 (20): 2108–16. doi:10.1056/NEJMcp0804878. PMID 19439745.
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