infectious diseases
Blastomycosis
Treatment of Blastomycosis
For mild to moderate disease,itraconazole For severe, life-threatening infection,amphotericin B Untreated blastomycosis is usually slowly progressive and is rarely ultimately fatal. Treatment of blastomycosis depends on severity of the infection. 200 mg orally 3 times a day for 3 days, followed by 200 mg orally once a day or 2 times a day for 6 to 12 months is used ( Treatment reference ). Forsevere, life-threatening infections,IVamphotericin Bis usually effective. The Infectious Diseases Society of America’s 2008guidelinesrecommend a lipid formulation ofamphotericin Bat a dosage of 3 to 5 mg/kg once a day oramphotericin Bdeoxycholate 0.7 to 1.0 mg/kg once a day for 1 to 2 weeks or until improvement is noted. Therapy is changed to oralitraconazoleonce patients improve; dosage is 200 mg 3 times a day for 3 days, then 200 mg 2 times a day for ≥ 12 months. Patients with central nervous system blastomycosis, pregnant patients, and patients who are immunocompromised should be treated with IVamphotericin B(preferably liposomalamphotericin B), using the same dose schedule as for life-threatening infection. Voriconazole,isavuconazonium, andposaconazoleare active againstB. dermatitidis, but clinical data are limited, and the role of these medications has not yet been defined. 1.Chapman SW, Dismukes WE, Proia LA, et al: Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America.Clin Infect Dis46(12):1801-1812, 2008. doi: 10.1086/588300 