Guidelines
Antifungal Therapy

Antifungal Therapy

Notes

Empirical antifungal therapy should be considered in high risk patients who are experiencing persistent fevers and no identified source after receiving 4-7 days of broad-spectrum antibiotic therapy. The choice of empiric antifungal therapy depends upon likely fungal pathogens, toxicities and cost.

If patient has not received antifungal prophylaxis, then candida infection is initially of greatest concern.

If patient receiving fluconazole prophylaxis, fluconazole resistant candida infections or an invasive mold infection more likely. Switch to an IV anti-mold agent within a different class.

Options

Dose: 0.5-1 mg/kg IV daily

Cost/Day: $100

Comments: Use in combination with aminoglycosides and/or vancomycin with extreme caution due to additive renal toxicities.

Dose: 800 mg IV/PO daily

Cost/Day:

  • PO: $1
  • IV: $10-15

Comments: Use only if patient has not received azole prophylaxis and is at low risk of invasive aspergillus infection.

Dose: 6 mg/kg IV/PO q12h x 2 doses, then 4 mg/kg IV/PO x 2 doses for invasive aspergilosis

Cost/Day:

  • PO: $4
  • IV: $120-150

Comments: Use only if patient has not received azole prophylaxis or is at high risk for invasive aspergillus.

Dose: 70 mg IV on Day 1, then 50 mg IV daily

Cost/Day: $150