Use of Antifungals in the Year 2008”

40 Pages·2008·3.48 MB·English

by  Authorized User

”Use of Antifungals in the Year 2008”
Jose G. Montoya, MD
Associate Professor of Medicine
Associate Chief for Clinical Affairs
Division of Infectious Diseases
Stanford University School of Medicine

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Microscopy (body fluids, i.e.: BAL)
helpful in alerting clinicians about the presence of mold-
(cid:132)
like or yeast-like structure
Pathology (H&E and fungal stains)
establishes the invasive nature of the disease
(cid:132)
Microbiology
identifies the fungal organism causing disease
(cid:132)
Serology
serves as a diagnostic aid by identifying Ag or AB
(cid:132)
Antigens: galactomanan, cryptococcal, histoplasma
(cid:122)
Antibodies: coccidiodomycosis, blastomycosis
(cid:122)
voriconazole
amphoB (lipid)
caspofungin
Aspergillus fumigatus
itraconazole
d
l
u Voriconazole
o
m

,
e
a
h
y Scedosporium apiospermum
h

,
i
g
n
u
f AmphoB (lipid)
l
a
i
l
e
?Posaconazole
c
y
m
Mucor sp.
Voriconazole +
Voriconazole QuickTime™ and a
TIFF (Uncompressed) decompressor Ampho B +
are needed to see this picture.
?Terbinafine
Aspergillus terreus Fusarium solani
Therapeutic Options for Invasive Fungal Infections
IV amphotericin B
(cid:139)
conventional
(cid:139)
lipid formulations
(cid:139)
amphotec, abelcet, ambisome
(cid:139)
IV/PO fluconazole
(cid:139)
IV/PO itraconazole
(cid:139)
IV/PO voriconazole
(cid:139)
PO posaconazole
(cid:139)
IV caspofungin, micafungin, anidulafungin
(cid:139)
combination therapy
(cid:139)
Mucormycosis