| Antifungals See updated page HERE |
| 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] |
