Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Primaxin ® , meropenem and doripenem are therapeutically interchangeable at the UWHC. Merrem ® is the preferredformulary product.Usual DoseAdult: 500 mg-1 gram Q6-8H IV (UWHC cost/day $94.56-252.16).Pediatrics:** 40-60 mg/kg/day IV, IM in divided doses Q6H.INDINAVIRFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/ITRACONAZOLEUsual DoseAdult: 200 mg Q24H PO (UWHC cost/day $11.08) or oral solution 200 mg Q24H (UWHC cost/day $24.44) For lifethreateninginfections, give a loading dose of 200 mg TID PO x 3 days, then 200-400 mg PO Q24H.Pediatrics:** 100 mg PO Q24H (for children 3 - 16 years).Indications1. Blastomycosis, pulmonary and extrapulmonary.2. Histoplasmosis, including chronic cavitary pulmonary disease and disseminated, non-meningeal histoplasmosis.3. Aspergillus infections (replaced by voriconazole as first-line therapy).4. Chromomycosis.5. Onychomycosis (200 mg Q24H x 12 weeks; “Pulse therapy” for onychomycosis of the fingernail consists of two 1-weekperiods of itraconazole 200 mg twice daily, each separated by a 3-week period without any drug. Therapy should continuefor three 1-week periods for treatment of onychomycosis of the toenail. (J Amer Acad Dermatol 1997;36:231-5 and ArchDermatol 1996;132:34-41).CommentsItraconazole attains low CSF levels but high brain tissue levels.NOTE: Itraconazole solution provides higher blood levels than the tablet formulation. For appropriate use, see Guidelinesfor the Use of Antifungal Agents (Appendix E) or on uconnect.Drug InteractionsFood enhances the absorption of itraconazole from capsules, but decreases absorption from the solution. Antacids,including the buffering agent in didanosine, proton pump inhibitors and histamine H 2 blockers decrease oral absorptionfrom capsules. Patients should be advised to take capsules with orange juice or cola. The oral solution should be takenon an empty stomach. Although not routinely used, itraconazole serum levels are useful in serious infections if poorabsorption or treatment failure is suspected. Serum levels should be measured 2-4 hours following a dose, or as a troughlevel, during the second week of therapy.Itraconazole is an inhibitor of the cytochrome P450 enzymes 2C9 and 3A4 as well as p-glycoprotein. Drugs that aremetabolized by these enzymes and may have increased drug levels when used concomitantly with itraconazole include:• Alosetron • Erlotinib • Oxycodone• Alprazolam (contraindicated) • Ergot alkaloids • Pazopanib• Amprenavir/fosamprenavir • Estrogens • Praziquantel• Antipsychotic drugs • Eszopiclone • Ranolazine• Aprepitant/fosaprepitant • Etravirine • Repaglinide• Benzodiazepines • Everolimus • Romidepsin• Bexarotene • Fentanyl • Salmeterol• Bortezomib • Fesoterodine • Saquinavir• Bosentan • Gefitinib • Saxagliptin• Buspirone • Halofantrine • Silodosin• Busulfan • HMG-CoA reductase inhibitors • Sirolimus• Cilostazol • Iloperidone • Solifenacin• Cinacalcet • Imatinib • Sunitinib