International Journal of Hepatology / 2012 / Article / Tab 1

Review Article

Fungal Infections: Their Diagnosis and Treatment in Transplant Recipients

Table 1

Antifungal agents currently available, mechanism of action, principle indications, and dosing schedule.

ClassAgentsIndicationDosing 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 BInvasive fungal infections include: aspergillosis, cryptococcosis, North American blastomycosis, systemic candidiasis, coccidioidomycosis, histoplasmosis, zygomycosis, Conidiobolus, Basidiobolus, sporotrichosis0.3–1.5 mg/kg

(2) AmBisomeEmpirical therapy in febrile neutropenic pts.3 mg/kg/day
Cryptococcal meningitis in HIV pts.6 mg/kg/day
Visceral leishmaniasis3-4 mg/kg/day

(3) Amphotericin B
Colloidal dispersion (ABCD)
No primary indication; only salvage therapy3–6 mg/kg

(4) Abelcet (ABLC)No primary indication only salvage5 mg/kg

Azoles Azoles inhibit cytochrome P450 14a demethylase (P45014DM) required for ergosterol synthesis

(1) VoriconazoleInvasive aspergillosis and candidemia in nonneutropenic patients6 mg/kg IV twice a day on day 1, then 4 mg/kg twice at day or 200 mg PO twice a day
Esophageal candidiasis200 mg PO twice a day given 1 hour before or after a meal

(2) FluconazoleProphylaxis in transplant pts, invasive candida infections 800 mg/day IV on day 1, then 400 mg/day
Oropharyngeal and esophageal candidiasis200 mg/day IV or PO on day 1, then 100 mg/day
Cryptococcal meningitis200 up to 400 mg/day IV or PO

(3) ItraconazoleEmpirical therapy in febrile neutropenic patients, blastomycosis, pulmonary and extrapulmonary, histoplasmosis, chronic pulmonary and disseminated, and nonmeningeal histoplasmosis200 mg IV twice a day or 100–400 mg po

  (4) PosaconazoleProphylaxis of invasive Aspergillus and Candida in immunocompromised patients200 mg (5 mL) three times a day with a full meal or nutritional supplement
Oropharyngeal candidiasis100 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) AnidulafunginCandidemia, acute disseminated candidiasis200 mg/day on day 1 then 100 mg/day
Esophageal candidiasis100 mg on day 1, then 50 mg/day

(2) CaspofunginCandidemia, acute disseminated candidiasis, empirical therapy in febrile neutropenic patients, and invasive aspergillus refractory to other therapies70 mg/day on day 1, then 50 mg/day
Esophageal candidiasis50 mg/day

(3) MicafunginCandidemia, acute disseminated candidiasis100 mg/day
Esophageal candidiasis150 mg/day
Prophylaxis of Candida infection in pt undergoing HSCT50 mg/day

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