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• Geneva has no stock and no emergency supplies. The company estimates Fungizone will be available by September 2003
• Pharma-Tek has no stock and no emergency supplies. The company estimates the product will be available by the end of
May
• Pfizer has no stock and no emergency supplies. The company estimates the product will be available by mid-June 2003
Due to the national shortage of amphotericin B deoxycholate and the present unavailability at UMMS for the next month, the
following measures will be temporarily implemented until the shortage is resolved, which is expected within 4 weeks.
1) Cancer Center
The Antifungal Guidelines for the Cancer Center will be followed. Abelcet®
(5 mg/kg) will be used in place of ampohotericin B deoxycholate for empiric therapy and curative therapy when appropriate if
ampphotericin B deoxycholate is unavailable.
a) Amphotericin B bladder irrigation will not be allowed. If treatment is indicated for urinary candidiasis, oral antifungal
should be used (i.e. fluconazole)
b) Candidemia – Fluconazole will be first line therapy as per dosing guidelines except in following settings with known C.
glabrata and/or C.krusei† colonization:
- Serum creatinine > 2 (scr>1.5 in children) or doubling of serum creatinine from baseline or estimated creatinine
clearance to be <50 ml/min
Abelcet® 5 mg/kg qd IV
Or
Caspofungin 70 mg load then 50 mg/day IV
- Hemodialysis - Abelcet 5 mg/kg or caspofungin 70 mg load then 50 mg/day IV
c) Empiric coverage for high-risk patients will continue to be Fluconazole (oral route preferred) unless known C. glabrata
and/or C.krusei† colonization, then follow candidemia recommendations if appropriate.
d) Renal transplantation – Fluconazole (dose based on renal function) is preferred. Alternative agents include, Abelcet® or
caspofungin (avoid use with cyclosporin; monitor tacrolimus level: increase maintenance dose of caspofungin to 70 mg when
used with enzyme inducers like rifampin)
3) HIV
a) Cryptococcal meningitis – Abelcet® 5mg/kg will be preferred agent for induction therapy. Fluconazole 400-mg qd
is an alternative therapy in mild disease.
Note: Caspofungin has no activity against Cryptococcus neoformans.
1) Candidiasis
Fluconazole
Premature Neonates:
29 weeks gestation:
Postnatal age 0-14 days: 5-6 mg/kg/ dose Q72H
Postnatal age >14 days: 5-6 mg/kg/dose Q48H
30-36 weeks gestation:
Postnatal age 0-14 days: 6mg/kg/dose Q48H
Neonates > 14 days, Infants and Children: Dose Frequency is Q24H Oropharyngeal Candidiasis
6 mg/kg/day on day #1, 3 mg/kg/day for 14 days
Esophageal Candidiasis
6 mg/kg/day on day #1, 3-6 mg/kg/day for 21 days (For serious or recurrent infection, may increase
dose to 12mg/kg/day)
Systemic Candidiasis
Loading dose: 12mg/kg/day, then 6 mg/kg/day for 28 days
Abelcet®
If suspected/colonize with C.Glabrata and/or C.Krusei-
Abelcet® (5mg/kg/day)
2) Cryptococcal Meningitis
Abelcet® 5mg/kg/day as induction therapy
Fluconazole is an alternative
Acute: 12 mg/kg/day on day #1, 6-12 mg/kg/day for 10-12 wk after CSF culture becomes negative
Relapse: 6 mg/kg/day
Fluconazole 6 milligram/kilogram once daily is recommended for suppression