McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

TABLE 11.1

DRUGS IN FOCUS Systemic antifungals

Drug name

Dosage/route

Usual indications

Azole antifungals fluconazole

Adult: 200–400 mg PO on day one, followed by 100 mg/day PO; IV route can be used, but do not exceed 200 mg/hour Paediatric: 3–6 mg/kg PO; do not exceed 12 mg/kg Adult: 100–400 mg/day PO Paediatric: safety and efficacy not established Adult: 200 mg/day PO, up to 400 mg/day PO in severe cases Topical: as a shampoo and topical

Treatment of candidiasis, cryptococcal meningitis, other systemic fungal infections; prophylaxis for reducing the incidence of candidiasis in bone marrow transplant recipients

(Canesoral, Diflucan,

Dizole)

itraconazole (Sporanox)

Treatment of blastomycosis, histoplasmosis and aspergillosis

ketoconazole (Nizoral)

Treatment of aspergillosis, leishmaniasis, cryptococcosis, blastomycosis, moniliasis, coccidioidomycosis, histoplasmosis and mucormycosis; topical treatment of mycoses (cream) and to reduce the scaling of dandruff (shampoo) Prophylaxis of invasive Aspergillus and Candida infections in adults and children >13 years who are immunosuppressed secondary to antineoplastic, chemotherapy, graft-versus-host disease following transplants or haematological malignancies dermatophytes; the drug was approved in late 2007 for treatment of tinea capitis (ringworm of the scalp) in children ≥4 years Treatment of invasive aspergillosis; treatment of serious fungal infections caused by Scedosporium apiospermum or Fusarium species when the person is intolerant to or not responding to other therapy Treatment of candidaemia (infection of the blood stream) and other forms of Candida infection, intraabdominal infections and oesophageal candidiasis Treatment of invasive aspergillosis in people who do not respond or are intolerant to other therapies Treatment of aspergillosis, leishmaniasis, cryptococcosis, blastomycosis, moniliasis, coccidioidomycosis, histoplasmosis and mucormycosis; use is reserved for progressive, potential fatal infections due to many associated adverse effects Treatment of systemic infections caused by Candida or Cryptococcus Treatment of onychomycosis of the fingernail or toenail caused by

posaconazole (Noxafil)

Adults and children ≥13 years: 200 mg PO t.d.s. with food

terbinafine (Lamisil, Tamsil)

250 mg/d PO for 6 weeks (fingernail) or 12 weeks (toenail)

voriconazole (Vfend)

Adult: 6 mg/kg IV q 12 hours for two doses, then 4 mg/kg IV q 12 hours; switch to oral dose as soon as possible

>40 kg: 200 mg PO q 12 hours <40 kg: 100 mg PO q 12 hours

Echinocandin antifungals anidulafungin (Eraxis)

100–200 mg IV on day one, then 50–100 mg/ day IV for 14 days; dose varies with infection being treated

caspofungin acetate (Cancidas)

Adult: 70 mg/day IV loading dose, then 50 mg/ day IV infusion; dose should be reduced to 35 mg/day IV infusion with hepatic impairment

Other antifungals amphotericin B (Abelcet, AmBisome, Fungilin)

0.25–1.5 mg/kg per day IV based on the infection being treated

flucytosine (Ancotil)

Adult: 37.5–50 mg/kg IV over 20–40 mins q 6 hours