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Infectious Disease - Antifungals

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.
(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]
(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]
(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]
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