NAPLEX Antifungal , Antiviral, Opportunistic infections

Candida albicans

Thrush:

Mild: clotirmazole or miconazole

Severe: diflucan

Alt: nystatin

Esophageal infection: diflucan

Candida krusei & glabrata

Bloodstream infection

Echinocandin (caspofungin, micafungin=mycamine)

Aspergillus

Vfend

Cryptococcal meningitis

Amphotericin B + flucytosine

Dermatophytes

Nail bed infection

Terbinafine or itraconazole

Flu

Tamiflu

Baloxavir (xofluza) one dose only in >5y

HSV1 & HSV2

HSV1: oropharyngeal

HSV2: genital

Herpes

Docosanol five times daily until healed

Acyclovir five times daily X4 days

Genital herpes & shingles

Acyclovir, Valtrex, famiclovir

Shingles: treat neuropathic pain w/ lyrica, gabapentin, cymbalta, TCA, NSAID, opioids

HSV encephalitis

IV acyclovir

CMV

1st: Ganciclovir or valganciclovir (valcyte)

Refractory: Foscarnet or cidofovir

Epstein-barr virus (EBV)

Mono

No drug treatment

Pneumocystitis jirovecci pneumonia (PJP or PCP) in HIV

CD4 < 100 cells

Bactrim DS/SS QD (bactrim also tx for disease)

Alt: dapsone, dapsone + pyrimethamine + leucovorin (used to decrease myelosuppression w/ pyrimethamine), or atovaquone

Stop if CD4 >200 for X3M

Toxoplasma gondii encephalitis in HIV

Toxoplasma IgG positive + CD4 < 100

Bactrim DS QD

Alt: dapsone, dapsone + pyrimethamine + leucovorin (used to decrease myelosuppression w/ pyrimethamine), or atovaquone

Stop if CD4 >200 for X3M

Mycobacterium avium complex (MAC) in HIV

Not recommended if ART start immediately

Initiate if not taking ART + CD4 < 50 + no active MAC infection

Azithromycin 1,200mg QD

Stop when taking fully suppressive ART

Toxoplasma gondii encephalitis treatment

Bactrim

Pyrimethamine + leucovorin + sulfadiazine

Mycobacterium avium complex (MAC) treatment

Clarithromycin or azithromycin + ethambutol