Treatment recommendations for disseminated histoplasmosis

Manifestation	Treatment
Progressive disseminated histoplasmosis
Moderately severe to severe	Liposomal AmB* (3 mg/kg daily), AmB lipid complex* (5 mg/kg daily), or AmB deoxycholate* (0.7 to 1 mg/kg daily) for one to two weeks followed by itraconazole^¶ (200 mg twice daily for at least 12 months)
Mild to moderate	Itraconazole^¶ (200 mg twice daily for at least 12 months)
CNS histoplasmosis	Liposomal AmB* (5 mg/kg daily for four to six weeks) followed by itraconazole^¶ (200 mg two to three times daily for at least 12 months)

With regard to pregnancy, all azoles are contraindicated in the first trimester because of the risk of teratogenicity; use later in pregnancy must balance possible risks with benefits. Otherwise, the indications for treatment are not different in pregnancy, and lipid formulations of AmB are preferred. AmB deoxycholate is preferred for use in children because it is effective, well tolerated, and less costly. The dosage of itraconazole for children is 5 to 10 mg/kg in two divided doses, not to exceed 400 mg daily.

AmB: amphotericin B; CNS: central nervous system.
* Liposomal AmB (3 mg/kg daily) or AmB lipid complex (5 mg/kg daily) are recommended for one to two weeks, except in patients with meningitis, for whom the dosage of liposomal AmB is 5 mg/kg daily for four to six weeks. The deoxycholate formulation of AmB (0.7 to 1 mg/kg daily) is an alternative to a lipid formulation in patients who are at low risk for nephrotoxicity.
¶ Itraconazole should be given as a loading dose of 200 mg three times daily for the first three days, followed by 200 mg twice daily thereafter. Concentrations of itraconazole in serum should be monitored in patients being treated for histoplasmosis; a random serum concentration between 1 and 2 mcg/mL should be sought. Drug monitoring is infrequently needed for patients receiving shorter courses of therapy for acute pulmonary histoplasmosis and its complications.

Modified with permission from: Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis 2007; 45:807. Copyright ©2007 University of Chicago Press.

Graphic 57457 Version 7.0

خرید پکیج

Treatment recommendations for disseminated histoplasmosis