Dosing schedule for antifungal prophylaxis and therapy.
| . | Daily Dosing . | |
|---|---|---|
| Agent . | Prophylaxis . | Treatment . |
| For prophylaxis, consider oral route when applicable. For preemptive, empirical therapy and therapy of established infection, start with IV route and shift to oral route when applicable. | ||
| * Itraconazole: 400 mg bid po (capsule or solution) or 200 mg bid IV. Use the IV formulation if severe mucositis or achlorhydria occurs. Capsule and solution should be taken with a cola beverage. Capsule is better absorbed with fat- and protein-rich meals, whereas the solution should be taken without meals. | ||
| † these doses effective for prevention of candidiasis. | ||
| § Voriconazole: 1-day loading: 400 mg bid po; 6 mg/kg bid IV. For prophylaxis against aspergillosis, consider higher doses. | ||
| ** For invasive aspergillosis use 3–5 mg/kg/day. The 1-mg/kg/day dose should only be used for candidal infections. Prophylaxis not supported by randomized trials. | ||
| ‡ Caspofungin: loading dose of 70 mg IV once. | ||
| Modified with permission from Thomson Current Drugs and Tahsine Mahfouz and Elias Anaissie, Prevention of fungal infections in the immunocompromised host. Current Opinion in Investigational Drugs. 2003 ;4 (8):974 –990.12 | ||
| Fluconazole | 200 to 400 mg po | 400 to 800 mg iv → po |
| Itraconazole* | 200 mg iv or 400 mg po bid | 200 mg iv or 400 mg po bid |
| Voriconazole § | Not tested | 3 to 4 mg/kg iv → po bid |
| Amphotericin B | 0.2 mg/kg/day or 0.5 mg/kg × 3/wk† | 1 to 1.5 mg/kg |
| ABCD (Amphotec) | Not tested | 3 to 5 mg/kg |
| ABLC (Abelcet) | Not tested | 5 mg/kg |
| LAMB** | 1 mg/kg or 2 to 3 mg/kg × 3/wk | 1 to 5 mg/kg |
| Caspofungin‡ | Not tested | 50 mg iv |
| . | Daily Dosing . | |
|---|---|---|
| Agent . | Prophylaxis . | Treatment . |
| For prophylaxis, consider oral route when applicable. For preemptive, empirical therapy and therapy of established infection, start with IV route and shift to oral route when applicable. | ||
| * Itraconazole: 400 mg bid po (capsule or solution) or 200 mg bid IV. Use the IV formulation if severe mucositis or achlorhydria occurs. Capsule and solution should be taken with a cola beverage. Capsule is better absorbed with fat- and protein-rich meals, whereas the solution should be taken without meals. | ||
| † these doses effective for prevention of candidiasis. | ||
| § Voriconazole: 1-day loading: 400 mg bid po; 6 mg/kg bid IV. For prophylaxis against aspergillosis, consider higher doses. | ||
| ** For invasive aspergillosis use 3–5 mg/kg/day. The 1-mg/kg/day dose should only be used for candidal infections. Prophylaxis not supported by randomized trials. | ||
| ‡ Caspofungin: loading dose of 70 mg IV once. | ||
| Modified with permission from Thomson Current Drugs and Tahsine Mahfouz and Elias Anaissie, Prevention of fungal infections in the immunocompromised host. Current Opinion in Investigational Drugs. 2003 ;4 (8):974 –990.12 | ||
| Fluconazole | 200 to 400 mg po | 400 to 800 mg iv → po |
| Itraconazole* | 200 mg iv or 400 mg po bid | 200 mg iv or 400 mg po bid |
| Voriconazole § | Not tested | 3 to 4 mg/kg iv → po bid |
| Amphotericin B | 0.2 mg/kg/day or 0.5 mg/kg × 3/wk† | 1 to 1.5 mg/kg |
| ABCD (Amphotec) | Not tested | 3 to 5 mg/kg |
| ABLC (Abelcet) | Not tested | 5 mg/kg |
| LAMB** | 1 mg/kg or 2 to 3 mg/kg × 3/wk | 1 to 5 mg/kg |
| Caspofungin‡ | Not tested | 50 mg iv |