DPT 3 fungal treatments

Esophageal Candidiasis

fluconazole 200-400mg for 14-21 days

Oropharyngeal candidiasis

Clotrimazole 10mg troche 5x daily

miconazole 50mg buccal tab daily

Moderate severe 100-200mg qd

all for 7-14 days

vulvovaginal

Topical azole depends on agent and stregth

Fluconazole 150mg once

candidemia

Echinocandin

fluconazole 800mg once then 400mg

14 day treatment after first negative

neutropenic candidemia

echinocandin

lamb

14 days after first negative culture

suspected IC

echinocandin

lamb

4-5 days then reassess

intra-abdominal candidiasis

echinocandin

fluconazole 800 once then 400

duration depends on resolution

intravascular candidiasis

LAMB +/- flucytosine

High dose echinocandin

6 weeks

osteoarticular candidiasis

echinocandin

fluconazole 800mg once then 400

6-12 months

CNS candidiasis

LAMB +/- flucytosine

(step down to fluconazole 400-800 po daily)

Duration depends

cystitis candidiasis

Fluconazole 200mg for 14 days

pylonephritis candidiasis

fluconazole 200-400mg for 14 days

cryptococcosis

CNS

Severe pulmonary

disseminated

High income settings:

LAMB + flucytosine

Low income settings

High dose LAMB once + Flucytosine + 1200mg fluconazole daily

Duration for both:

indiction - 2 weeks and CSF sterilization

Consolidation - 8 weeks 400-800mg fluconazole

maintenance - 12 months fluconazole 200mg daily

invasive aspergilosis

voriconazole

isavuconazole

LAMB

Posaconazole 6 -12 weeks for all

mucormycosis (Rhizopus, Mucor, and Lichtheimia species)

LAMB

Isavuconazole

Posaconazole

blastomycosis

LAMB

Mild- itraconazole

6-12 months

Coccidioimycosis

LAMB till improved then step down

CNS high dose fluconazole

- step down is 400mg fluconazole

12 months for severe

Lifetime for CNS

mild moderate 3-6 months

Histoplasmosis

LAMB 1-2 weeks

CNS: LAMB 4-6 weeks

Mild moderate 200mg po TID for 3 daysthen 200mg BID

12 months for severe, 6 for mild moderate if immunocompromised

Paracoccidioimycosis

ABLC q 24

CAMB

either for 14-28 days then step down to

itraconazole 200 po BID

9-12 months

sporotrichosis

LAMB till improved then

Itraconazole

12 months

Mild moderate itraconazole 3-6 months

capitis

Terbinafine 250 qd

or

griseofulvin

+ Topical (ketoconazole, selenium sulfide)

4-8 weeks

Corporis

cruris

pedis

topical:

allylamines, azoles

Oral:

Terbinafine

fluconazole

griseofulvin

itraconazole

2-4 weeks

unguium

nail lacquers: ciclopirox, efinconazole, tavaborole

48 weeks low success

Oral:

terbinafine - 6 weeks fingers 12 weeks toes

fluconazole - 3 months fingers 12 months toes

itraconazole - 2 months fingers 3 months toes