Fungal Infection Pharmacology

Question 1

Candida albicans treatment

Answer 1

Amphotericin B IV and fluconazole

Question 2

Cryptococcus neoformans treatment

Answer 2

CNS: Amphotericin B IV + flucytosine
PO
Non-CNS: fluconazole PO

Question 3

Aspergillus treatment

Answer 3

1st line: voriconazole IV

step down: voriconazole PO

Question 4

Blastomyces dermatitidis

Answer 4

1st line: fluconazole IV or amph B IV if
severe
step down: voriconazole or
itraconazole or fluconazole

Question 5

Histoplasma capsulatum

Answer 5

Severe or immunocompromised:
Amphotericin B IV followed by
itraconazole PO
Mild-moderate: Itraconazole PO
Updated: Voriconazole or posaconazole fluconazole
PO

Question 6

Coccidioides immitis

Answer 6

Severe or immunocompromised:
Amphotericin B IV followed by
itraconazole or fluconazole PO
Mild-moderate: Itraconazole or
fluconazole PO
Updated: Voriconazole or posaconazole PO

Question 7

Aspergillus resistance

Answer 7

Azole resistance by Aspergillus species is on the increase, possibly due to increased clinical use, but also to increased agricultural use of azole-like compounds. Resistance seems to be associated with mutations in the promotor region of CYP51A, which encodes lanosterol-14a-sterol demethylase activity

Question 8

Azoles cyps

Answer 8

Azoles undergo hepatic CYP metabolism and interact with concurrent drugs metabolized via CYP2C9, 2C19 & 3A4.

Question 9

Flucytosine adverse reactions

Answer 9

For flucytosine, caution is advised with other hematotoxic drugs because flucytosine can itself produce anemia, and blood dyscrasias, including agranulocytosis