Therapeutic Guidelines in Systemic Fungal Infection

Contents
Preface to the First Edition vii
Preface to the Third Edition viii
Clinical and Laboratory Diagnosis 1
1 Definitions of fungal infections 2
2 Categories of risk groups for systemic fungal
infection 7
3 Essential clinical examination in neutropenic
and solid organ transplant patients with
suspected invasive fungal infection 8
4 Investigation of pulmonary infection in
neutropenic and solid organ transplant
patients 9
5 Essential investigations for the laboratory
diagnosis of systemic fungal infections 10
6 Fungal species most commonly recovered
from clinical specimens 17
7 Criteria for the diagnosis of systemic fungal
infections: clinical features and laboratory
parameters contributing to a definitive
diagnosis 19
8 Assessment of the response to antifungal
therapy – definitions 22
iv
Antifungal Drugs 23
9 Amphotericin B 24
10 Regimen for rapid escalation of amphotericin B
dosage 27
11 Regimen for gradual escalation of
amphotericin B dosage 28
12 Liposomal amphotericin B (AmBisome®) 29
13 Amphotericin B colloidal dispersion
(Amphocil®, Amphotec®) 33
14 Amphotericin B lipid complex (Abelcet®) 37
15 Pharmacokinetic comparisons of
amphotericin B formulations 40
16 Polyene comparisons: infusion-related
reactions 41
17 Polyene comparisons: nephrotoxicity 43
18 Caspofungin 44
19 Fluconazole 48
20 Flucytosine (5-fluorocytosine) 53
21 Regimens for administration of flucytosine in
renal impairment 56
v
22 Itraconazole 57
23 Voriconazole 64
Therapy of Specific Infections 69
24 Aspergillosis 70
25 Prevention of invasive aspergillosis 75
26 Blastomycosis 78
27 Candidosis 80
28 Coccidioidomycosis 86
29 Cryptococcosis 88
30 Histoplasmosis 91
31 Mucormycosis 94
32 Paracoccidioidomycosis 96
33 Penicillium marneffei infection 97
34 Sporotrichosis 98
vi
35 Unusual fungal infections 99
Prophylaxis 101
36 Prophylaxis alternatives 102
37 Examples of risk factors triggering targeted
prophylaxis/pre-emptive therapy 105
Empirical Treatment of the Persistently
Febrile Neutropenic Patient 106
38 Recommended empirical treatment 107
39 Current recommended initial strategy 108
Combination Treatment and Antifungals
Under Development 109
40 Combination therapy: the issues 110
41 Antifungals under development 111
General references 115
Web sites 117
Abbreviations 118