Infectious Diseases II
| (2) | Ibuprofen 600 mg orally |
|---|---|
| (3) | Acetaminophen 650 mg orally with diphenhydramine 50 mg orally |
| (4) | Meperidine 25โ50 mg intravenously if patient previously experienced rigors |
| (b) | Use lower infusion rate on dose initiation. |
Lipid amphotericin (liposomal amphotericin and amphotericin B lipid complex)
Amphotericin dissociates from lipid over time, which may limit its renal toxicity and infusion-
related reactions.
ii.
Premedication may still be necessary for amphotericin B lipid complex.
Mechanism of action: Inhibits the synthesis of ergosterol through blocking the CYP enzyme 14-ฮฑ-sterol-
demethylase. Inhibition of this enzyme leads to the accumulation of 14-ฮฑ-methyl sterols on the fungal
surface, which in turn leads to fungal cell death.
Spectrum of activity:
Candida spp.
| (a) | Candida krusei is intrinsically resistant. |
|---|---|
| (b) | Variable sensitivity with Candida glabrata. Should not be used for C. glabrata unless |
antifungal susceptibilities are available. If C. glabrata is sensitive dose-dependent, higher
doses may be necessary (12 mg/kg/day).
| (c) | Good activity against all other pathogenic Candida spp. |
|---|
ii.
Cryptococcus
Dose
6โ12 mg/kg/day (400โ800 mg/day)
ii.
Available in intravenous and oral formulations
iii.
Well absorbed orally with high bioavailability
iv.
Primarily excreted by the kidneys โ Renal dose adjustments are necessary.
Adverse effects: Minimal adverse effects and lowest propensity for drug interactions among
triazoles
Itraconazole
Spectrum of activity
Candida spp. โ Has coverage similar to fluconazole with the addition of activity against C.
krusei
ii.
Aspergillus, Blastomyces, Histoplasma
Dose
200โ400 mg once daily
ii.
Intravenous formulation no longer available
iii.
Poor and erratic oral absorption. Improved with oral liquid formulation, maintaining high
stomach acidity, avoidance of acid-suppressive therapy, and coadministration with acidic
beverage
iv.
Therapeutic drug monitoring may be necessary. Please see the Pharmacokinetics/
Pharmacodynamics chapter for further discussion.
Primarily used for fungal prophylaxis in immunocompromised patients and treatment of
endemic fungi (histoplasmosis, blastomycosis)
Adverse effects
GI upset, increase in liver function tests
ii.
Drug interactions: CYP 3A4 and 2C9 inhibitor