CPJE Secrets 2026: Systemic Fungal Infections

Amphotericin B

Amphotec, Fungizone, Abelcet (lipid), AmBisome (liposomal)

Pregnancy category B

Decreases K and Mg

Monitor for hepatotoxicity and nephrotoxicity.

Compatible with D5W only.

Flucytosine

Ancobon

Fluorouracil prodrug.

Causes bone marrow suppression, avoid mono therapy. due to rapid resistance

Echinocandins

“-fungin”

Monitor for hepatotoxicity

Caspofungin

Cancidas

50mg IV QD; ONLY NS

Micafungin

Mycamine

100mg IV QD

Anidulafungin

Eraxis

100-200mg IV QD

Rezafungin

Rezzayo

400mg IV once on day 1, then 200mg qwk beginning on day 8 for up to 4 doses

Azole Antifungals

Monitor for CYP3A4, hepatotoxicity

Ketoconazole

Nizoral

400mg QD

BBW: hepatotoxicity

Needs acidic pH, avoid PPI, antacids, H2RAs

Fluconazole

Diflucan

150mg tablet once

Possible hepatotoxicity/skin rash if taken longer

IV:PO = 1:1!

Itraconazole

Sporanox

400mg QD

BBW: HF

Oral capsules cannot be substituted for solution. Capsules need food, solution can be done empty stomach.

Need acidic pH, avoid antacids, H2RAs, PPIs.

Voriconazole

Vfend

300mg q12h OR 4-6mg/kg IV

Drug of choice: Apergillus

Visual changes, photosensitivity, hepatotoxic.

Tablets contain lactose, liqdui contains sucrose.

Take on empty stomach.

IV reconstitution immediate use, do NOT refrigerate.

Posaconazole

Noxafil

Use dosing spoon, take with full meal

Broadest spectrum, fewest drug interactions

Isavuconazonium

Cresemba

372mg IV/PO q8h for 6 doses → 372 IV/PO QD

For invasive aspergillosis/mucormycosis.

Oral Yeast Infection Treatment

Topical

Mycostatin (nystatin) suspension 4-5 times daily OR

Mycelex (clotrimazole) lozenges

Oral

Fluconazole, itraconazole

Vaginal Candida Infection Treatment

Oral

Diflucan 150mg PO once OR Sporanox OR

Brexafemme (ibrexafungerp) 2 150mg tabs in AM and 2 in PM

Intravaginal/Topical (OTC) Regimens

• Gyne-Lotrimin-7, Myxcelex-7 (clotrimazole) 1% cream or 100mg suppository for 7 days

• Monistat-1/3/7 (miconazole) suppository 1.2g for 1 day OR 200mg for 3 days OR 100mg for 7 days

• Mycostatin (nystatin) vaginal insert 14 days

• Femstat-3, Gynazole-1 2% cream 5g for 1-3 days

• Vagistat-1 (tioconazole) 6.5% ointment 5g once

• Terazol (terconazole) 0.4% cream for 7 days OR 0.8% for 3 days OR Zazole suppository 80mg for 3 days

All topicals are safe during pregnancy!

Recurrent Vulvovaginal Candidiasis Treatment

Oteseconazole-only

• Day 1: 600mg PO once

• Day 2: 450mg

• Day 14: 150mg PO per week for 11 weeks (2-12)

Oteseconazole + Diflucan

• Days 1,4,7: Diflucan 150mg PO x1

• Days 14-20: Oteseconazole 150mg PO QD for 7 days

• Day 28: Oteseconazole 150mg PO per week for 11 weeks (4-14)