Infectious Disease III: Viral, fungi, and immunocompromised

amphotericin B covers

broad spectrum antifungal;

Yeasts: most candida

molds: aspergillus

conventional amphotericin B doses should not exceed

1.5 mg/kg/day (cardiopulmonary arrest risk)

amphotericin B AE

low K, low MG, nephrotoxic, infusion related reactions

amphotericin B deoxycholate (convention

al formulation) should be pretreated with...

ASA or NSAID

diphenhydramine and/or hydrocortisone

____ is used with amphotericin B to treat invasive cryptococcal (e.g. meningitis) or Candida infections

Flucytosine

Azole antifungals

Fluconazole, voriconazole, posaconazole

Azoles AE

inc LFT, QT prolongation, many drug interactions

Only azole that requires renal dose adjustment

Fluconazole

Azole antifungal which can cause HF

itraconazole

azole antifungal which can cause visual disturbance and phototoxicity

voriconazole

echinocandins

Caspofungin

Micafungin

Anidulafungin

echinocandins MOA

Inhibit cell wall synthesis by inhibiting synthesis of β-glucan.

caspofungin and micafungin warnings

histamine-mediated symptoms (rash, pruritis, facial swelling)

Nystatin administration

-topical powder

-oral (swallow or swish/spit)

terbinafine warnings

hepatotoxicity (avoid in active liver disease)

Candida albicans oropharyngeal infection (oral thrush) preferred treatment

clortrimazole, miconazole

Candida albicans esophageal infection preferred treatment

fluconazole

Candida bloodstream infections preferred treatment

echinocandin

Invasive aspergillus preferred treatment

Voriconazole

cryptococcus meningitis preferred treatment

amphotericin B + flucytosine

dermatophytes (nail bed infection) preferred treatment

terbinafine or itraconazole

Tamiflu should be given within

48 hours of illness onset

Neuraminidase inhibitors

Oseltamivir (Tamiflu), zanamivir, paramivir

Tamiflu decreases the durations of symptoms by

1 day

Tamiflu AE

N/V, neuropsych

HSV1 is most commonly associated wtih

oropharyngeal disease

HSV2 is most commonly associated with

genital disease

Treatment for HSV and varicella zoster virus

Acyclovir, valacyclovir, famiclovir

acyclovir and valacyclovir warnings

caution in renal impairment, geriatrics, concomitant nephrotoxic medications

herpes simplex labialis (cold sores) treatment

docosanol

acyclovir

apply 5 times daily

genital herpes treatment

Acyclovir, valacyclovir

herpes zoster treatment and duration

acyclovir or valacyclovir for 7 days

cytomegalovirus treatment

Ganciclovir

Valganciclovir

Ganciclovir and Valganciclovir boxed warning

myelosuppression

Mono treatment

supportive

A patient on steroids for at least ___ days is considered immunocompromized

14

common opportunistic infections requiring prophylaxis in immunocompromised patients

PJP or PCP

toxoplasmosis gondii encephalitis

mycobacterium avium complex

primary prophylaxis for PJP/PCP

SMX/TMP

alternatives: dapsone, atovaquone, or dapsone + pyrimethamine + leucovorin

criteria for discontinuing PJP/PCP prophylaxis

CD4 count > 200 for >3 months

toxoplasmosis gondii encephalitis prophylaxis

SMX/TMP

alternatives:

atovaquone or dapsone + pyrimethamine + leucovorin

mycobacterium avium complex prophylaxis

azithromycin

mycobacterium avium complex criteria for discontinuing ppx

taking fully suppressive ART

treatment of oral thrush in immunocompromised patient

fluconazole

treatment of cryptococcal meningitis in immunocompromised patient

amphotericin B + flucytosine

treatment of CMV in immunocompromised patient

valganciclovir or ganciclovir

treatment of mycobacterium avium complex in immunocompromised patient

clarithromycin or azithromycin + ethambutol

treatment of PJP in immunocompromised patient

SMX/TMP

treatment of toxoplasmosis gondii in immunocompromised patient

pyrimethamine + leucovorin + sulfadiazine