Fungal Infections

25 Drugs classified under this therapeutic system

Antifungal. Amphotericin B 50 mg/vial.
VIALS: 10. 1 mg/kg bdy. wt. dly. incr.
step-wise as reqd. I.V. infus. over 30-60
mins. See lit.
Severe system. and/or deep mycoses,
where toxicity (partic. nephrotox.)
precludes use of convent. ther., syst. fung.
infects. in immunocomp. pts., prim. ther.
visceral leishman. in immunocompetent
pts., immuno-compromised pts. e.g. HIV pos.
C/I: Hypersens.

Antifungal. Caspofungin (as acetate) 50 mg/vial.
VIALS: (lyophilized pwdr. for inject.): 1 x
50 mg, 70 mg. Single 70 mg load. dose
on day 1, foll. by 50 mg dly by slow I.V.
infus. over approx. 1 hr.
Candidemia and other candida infects:
intra-abdom. abscesses, peritonit.,
pleural space infects. Esophag. candidias.
Invas. aspergillosis in pts. who are
refractory to or intol. of other therap.
C/I: Hypersens.

Antifungal. Caspofungin (as acetate) 70 mg/vial.
VIALS: (lyophilized pwdr. for inject.): 1 x
50 mg, 70 mg. Single 70 mg load. dose
on day 1, foll. by 50 mg dly by slow I.V.
infus. over approx. 1 hr.
Candidemia and other candida infects:
intra-abdom. abscesses, peritonit.,
pleural space infects. Esophag. candidias.
Invas. aspergillosis in pts. who are
refractory to or intol. of other therap.
C/I: Hypersens.

Antimycotic, Triazole Derivatives. Isavuconazole 100 mg.
CAPS.: 14. Loading dose is 2 caps (200mg)×3/d every 8 hrs. for the first 48 hrs. (6 admin. in total).
Mainten. dose: 2 caps. (200mg)×1/d, start. 12-24 hrs. after the last load. dose. Durat. of ther. should be determin. by the clinic. response.
For long-term tmt. beyond 6 mnths., the benefit-risk balance should be careful. consid.
Tmt. of invas. aspergillosis; mucormycosis in pt. for whom amphotericin B is inapprop.  Consider. should be given to offic. guidance on the approp. use of antifung. agents.
C/I: Hypersens. Co-admin. with ketoconazole. Co-admin. with high-dose ritonavir (>200 mg every 12 hrs). Co-admin. with strong CYP3A4/5 induc. such as rifampicin, rifabutin, carbamazepine, long-act. barbiturates (e.g. phenobarbital), phenytoin and St. John’s wort or with moder. CYP3A4/5 induc. such as efavirenz, nafcillin & etravirine. Pts. with famil. short QT syndr.

Antimycotic, Triazole Derivatives. Isavuconazole 200 mg.
VIAL (pwdr. for concentrat. for sol. for infus.): 1×10ml. Load. dose: The recomm. load. dose is 1 vial after reconstit. & dilute. (equiv. to 200 mg of isavuconazole) every 8 hrs. for the first 48 hrs. (6 admin. in total).
Mainten. dose: The recom. mainten. dose is one vial after reconstit. and dilute. (equiv. to 200 mg of isavuconazole) once dly., starting 12- 24 hrs. after the last load. dose.
Durat. of therapy should be determ. by the clinical response.
For long-term tmt. beyond 6 mnths., the benefit-risk balance should be carefully considered.
Switch to oral isavuconazole: This drug  is also available as hard caps. contain. 100 mg isavuconazole, equiv. to 186 mg isavuconazonium sulfate. See lit.
Indic. in adult. for the tmt. of: Invasive aspergillosis, mucormycosis in pts. for whom amphotericin B is inappropr.
Consideration should be given to official guidance on the appropr. use of antifung. agents.
C/I: Hypersens. Co-admin. with ketoconazole. Co-admin. with high-dose ritonavir (>200 mg every 12 hrs.).
Co-admin. with strong CYP3A4/5 induc. such as rifampicin, rifabutin, carbamazepine, long-act. barbiturates (e.g. phenobarbital), phenytoin and St. John’s wort or with moder. CYP3A4/5 induc. (e.g. efavirenz, nafcillin, etravirine). Pts. with familial short QT syndr.

Antifungal, Antiinfectives. Miconazole 20 mg/g.
ORAL GEL: 40 g.
Oropharyngeal candidosis: Infants
(6-24 mnths): 1.25 mL of gel x 4/d after
meals. Adults, children (>2 yrs old): 2.5
mLof gel x 4/d after meals.
GI tract candidosis: Infants (≥ 6
mnths), Children, Adults: 20 mg/kg/day x 4 divided doses. The daily dose
should not exceed 250 mg x 4/d. See
lit.
Oral mycosis (thrush), fungal infect. of the
upper GI tract. Prevent. of oral thrush in
pts receiv. long-termtmt with antibiotics,
steroids, cytotoxic and radiation ther.
C/I: Hypersens. to act. ingred.,exipient,
or other imidazole derive.; infants under
6 mnths. or in those whose swall. reflex
is not yet suffic. developed; pts.with
liver dysfunct.; Coadmin.of the foll.
drugs that are subject to metab. by
CYP3A4: Substr. known to prolong the
QT-interval e.g., astemizole, bepridil,
cisapride, dofetilide, halofantrine,
mizolastine, pimozide, quinidine,
sertindole and terfenadine; Ergot
alkaloids;HMG-CoA reduct.inh. such as
simvastatin and lovastatin; Triazolam,
oral midazolam.