Antifungals
|
| Ampho
B: |
Test
dose: (optional):
1 mg/20-50 ml D5W over 10-30 minutes. Monitor temp,
pulse, RR and BP q30min x 4 hours. Do not give premeds
with test dose.
Maintenance dose:
Initially give 0.25-0.3 mg/kg/day. Increase as
tolerated by an equivalent amount once daily. Usual
daily dose: 0.5-1 mg/kg/day or up to 1.5 mg/kg every
other day. For life-threatening infection may give
full dose the first day (usually 0.6-0.7 mg/kg IBW on
Day # 1). Premedication: Prevention
of fever/chills: Tylenol 650mg PO/PR + Benadryl
25-50mg PO/IVP 60min prior to maintenance
infusion. May also add: Hydrocortisone 25-50mg IV/IM
+/- Demerol 50mg IV.
Renal dosing:
<10/ q24-36h. During therapy if the BUN increases
above 40 mg/dl or the serum creatinine exceeds 2.5-3
mg/dl, Hold Ampho B until renal function improves,
then restart at a reduced dose or change to every
other day dosing until the serum creatinine/BUN
improve.
Bladder
irrigation:
Add 30-50mg Ampho B to 1000ml (or less) sterile H2O
administered intermittently or continuously for 2 to
14 days. (Note: use of D5W for Bladder irrigations is
not recommended because of the possibility of
enhancing microbial and fungal growth in the bladder).
|
| Ampho
B lipid (Albecet ®): |
5
mg/kg/day IV. |
| Clotrimazole
(Mycelex ®): |
Oral
troches 5 x/day x 14 days. |
fluconazole
(Diflucan ®) |
Vaginal
candidiasis:
150 mg x 1. Systemic candidiasis: 400 mg orally
or IV once daily. Esophageal
candidiasis: 100-200 mg orally once daily (up to
400mg/day). Cryptococcal meningitis:
400mg orally x 1, followed by 200mg once a day x
10-12 weeks (Suppression: 50-200mg orally once
daily). Onychomycosis: 200-300mg once a week or
100-200mg orally every other day (further
studies needed). IV: since oral
absorbtion is rapid and essentially complete--IV
dose=oral dose. |
| flucytosine
(Ancobon ®): |
50-150
mg/kg/day orally in 4 divided doses. |
| Griseofulvin: |
microsize:
tinea: 11 mg/kg up to 500 mg orally once daily. |
| Itraconazole
(Sporanox ®): |
Systemic
mycosis:
200mg orally once daily with food (up to maximum of
400mg/day if unsatisfactory clinical response with
lower dose). Doses >200mg are given in 2
divided doses. Onychomycosis: 200mg orally
twice daily for 1 week each month for 2 months
(fingernails); x 3-4 months (toenails).
Oropharyngeal candidiasis: 200mg (20ml)-oral
solution-swish vigorously then swallow once daily x
1-2 weeks. Esophageal candidiasis: 100mg (10ml)
oral solution--swish and swallow once daily x 3 weeks.
May increase to 200mg/day. Life-threatening
infections: Loading dose: 200mg orally 3 times
daily should be given for the first 3 days of therapy,
then 200-400mg/day. |
| ketoconazole
(Nizoral ®): |
200-400
mg orally once daily. |
| nystatin
(Mycostatin ®): |
Thrush:
4 to 6 ml orally (swish/swallow) 4 times a day. |
| terbinafine
(Lamisil ®): |
Superficial
mycoses(tinea
corporus, cruris, pedis, capitis; cutaneous
candidiasis): 250 mg orally once daily. Onychomycosis:
(fingernails) 250mg orally once daily x 6 weeks or
pulse dosing: 500mg orally once daily for 1st week of
month x 2 months. (Toenails): 250mg orally once daily
x 12 weeks or pulse dosing: 500mg once
daily for 1st week of month x 4 months. Systemic
mycosis: 250-500mg orally once daily. |
|
Topical
Antifungals
|
| butenafine
(Mentax ®) |
Apply
cream once or twice daily. [cream 1%] |
| ciclopirox
(Loprox ®): |
Apply
cream or lotion twice daily [cream/lotion 1%] |
| clotrimazole
(Lotrimin ®): |
Apply
twice daily. Supplied: [1% cream
/solution /lotion] |
| enconazole
(Spectazole ®): |
Tinea:
apply once daily. Candida: apply twice daily.
Supplied:[1% cream] |
ketoconazole:
(Nizoril ®) |
Tinea/candida:
apply once a day Supplied: [2% cream].
Seborrheic dermatitis: apply shampoo/cream once
or twice daily. Dandruff: shampoo 2 times per week. |
| Miconazole: |
Tinea/candida:
apply twice a day. Supplie: [2%
cream/powder/spray] |
naftifine
(Naftin ®): |
Tinea:
apply once daily (cream) or twice a day- (gel) |
| nystatin: |
candidiasis:
apply 2 to 3 times daily. Supplied: [cream
/ powder/ ointment] |
| oxiconazole
(Oxistat ®): |
Tinea:
apply once or twice daily. Supplied:
[cream/lotion 1%] |
| terbinafine
(Lamisil ®): |
Tinea:
apply once or twice daily. Supplied:
[cream 1%] |
| tolnaftate
(Tinactin ®): |
Apply
twice a day. Supplied: [1% cream /powder/
gel /solution] |