|
Class | Agents | Indication | Dosing schedule |
|
Polyenes | |
Polyenes bind to sterols, preferentially to the primary fungal cell membrane sterol, and ergosterol. This binding disrupts osmotic integrity of the fungal membrane | |
|
| (1) Amphotericin B | Invasive fungal infections include: aspergillosis, cryptococcosis, North American blastomycosis, systemic candidiasis, coccidioidomycosis, histoplasmosis, zygomycosis, Conidiobolus, Basidiobolus, sporotrichosis | 0.3–1.5 mg/kg |
|
| (2) AmBisome | Empirical therapy in febrile neutropenic pts. | 3 mg/kg/day |
Cryptococcal meningitis in HIV pts. | 6 mg/kg/day |
Visceral leishmaniasis | 3-4 mg/kg/day |
|
| (3) Amphotericin B Colloidal dispersion (ABCD) | No primary indication; only salvage therapy | 3–6 mg/kg |
|
| (4) Abelcet (ABLC) | No primary indication only salvage | 5 mg/kg |
|
Azoles | |
Azoles inhibit cytochrome P450 14a demethylase (P45014DM) required for ergosterol synthesis | |
|
| (1) Voriconazole | Invasive aspergillosis and candidemia in nonneutropenic patients | 6 mg/kg IV twice a day on day 1, then 4 mg/kg twice at day or 200 mg PO twice a day
|
Esophageal candidiasis | 200 mg PO twice a day given 1 hour before or after a meal |
|
| (2) Fluconazole | Prophylaxis in transplant pts, invasive candida infections | 800 mg/day IV on day 1, then 400 mg/day
|
Oropharyngeal and esophageal candidiasis | 200 mg/day IV or PO on day 1, then 100 mg/day
|
Cryptococcal meningitis | 200 up to 400 mg/day IV or PO |
|
| (3) Itraconazole | Empirical therapy in febrile neutropenic patients, blastomycosis, pulmonary and extrapulmonary, histoplasmosis, chronic pulmonary and disseminated, and nonmeningeal histoplasmosis | 200 mg IV twice a day or 100–400 mg po |
|
| (4) Posaconazole | Prophylaxis of invasive Aspergillus and Candida in immunocompromised patients | 200 mg (5 mL) three times a day with a full meal or nutritional supplement
|
Oropharyngeal candidiasis | 100 mg (2.5 mL) twice a day on day 1, then 100 mg (2.5 mL) once a day with a full meal or nutritional supplement |
|
Echinocandins | |
The glucan synthesis inhibitors block fungal cell wall synthesis by inhibiting the enzyme 1,3-beta glucan synthase | |
|
| (1) Anidulafungin | Candidemia, acute disseminated candidiasis | 200 mg/day on day 1 then 100 mg/day
|
Esophageal candidiasis | 100 mg on day 1, then 50 mg/day |
|
| (2) Caspofungin | Candidemia, acute disseminated candidiasis, empirical therapy in febrile neutropenic patients, and invasive aspergillus refractory to other therapies | 70 mg/day on day 1, then 50 mg/day |
Esophageal candidiasis | 50 mg/day |
|
| (3) Micafungin | Candidemia, acute disseminated candidiasis | 100 mg/day |
Esophageal candidiasis | 150 mg/day |
Prophylaxis of Candida infection in pt undergoing HSCT | 50 mg/day |
|