Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Candidemia or candidiasis 11Non-neutropenicNeutropeniaw/out metastaticcomplicationsw/out metastaticcomplicationsChronic Disseminated CandidiasisOsteomyelitisSeptic ArthritisCNS CandidiasisAspergillosis 12Last Guideline: 2009 / Projected Update: Unknown2 weeks after documented clearance from the bloodstream and resolution ofsymptoms attributable to candidemia PLUS catheter removal stronglyrecommended2 weeks after documented clearance from the bloodstream, resolution ofsymptoms attributable to candidemia, and resolution of neutropenia PLUScatheter removaluntil lesions have resolved (usually months) and should continue throughperiods of immunosuppression6-12 months: fluconazole6 weeks: fluconazoleUntil all signs and symptoms, CSF abnormalities have resolvedLast Guideline: 2008 / Projected Update: UnknownDuration of therapy considerations1. Duration of therapy for most aspergillosis conditions has not been optimally defined. Duration is dependent on: site ofinfection, extent of disease, level of immune suppression & ability to reverse immune suppression2. Should be determined by resolution of clinical & radiological findings with or without normalization of galactomannanantigenemia6 - ≥12 weeks: Therapy should be continued throughout the period ofInvasive Pulmonary Aspergillosisimmunosuppression and until lesion resolutionOsteomyelitis &Septic ArthritisBlastomycosis 13ImmunocompetentImmunocompromised> 6-8 weeksLong-term suppressive therapy or treatment throughout immunosuppressionLast Guideline: 2008 / Projected Update: UnknownPulmonaryBlastomycosisDisseminatedExtrapulmonaryBlastomycosisCNS BlastomycosisModerately severeto severe diseaseMild to moderatediseaseModerately severeto severe diseaseMild to moderatediseaseOsteoarticularBlastomycosis in ImmunosuppressedPatientsCryptococcal Disease 14CryptococcalMeningoencepalitisHIV-Infected1-2 weeks (or until improvement): Lipid amphotericin 3-5mg/kg/day orAmB deoxycholate @ 0.7-1 mg/kg/day then3 days: Itraconazole 200mg PO TID then6-12 months: Itraconazole 200mg PO BID3 days: Itraconazole 200mg PO TID then6-12 months: Itraconazole 200mg PO BID1-2 weeks (or until improvement): Lipid amphotericin 3-5mg/kg/day orAmB deoxycholate @ 0.7-1 mg/kg/day then3 days: Itraconazole 200mg PO TID then6-12 months: Itraconazole 200mg PO BID3 days: Itraconazole 200mg PO TID then6-12 months: Itraconazole 200mg PO BID> 12 months of antifungal therapyLipid AmB @ 5mg/kg/day for 4-6 weeks thenOral azole therapy with either fluconazole, itraconazole, or voriconazole1-2 weeks (or until improvement): Lipid amphotericin 3-5mg/kg/day orAmB deoxycholate @ 0.7-1 mg/kg/day then3 days: Itraconazole 200mg PO TID then≥12 months: Itraconazole 200mg PO BIDConsider lifelong suppressive therapy for oral itraconazole 200mg per day ifimmunosuppression cannot be reversed & in patients with relapses despiteadequate treatmentLast Guideline: 2010 / Projected Update: UnknownInduction:AmB deoxycholate or lipid AmB plus flucytosine for 2 weeks orAmB deoxycholate or lipid AmB (for flucytosine-intolerant patients) for 4-6weeksConsolidation:Fluconazole for 8 weeksMaintenance:Fluconazole (preferred-superior) or itraconazole or AmB deoxycholate for >1year