CAn Micro 43 2548,2005) Concomitant antifungal rx may also I sensitivity (CID 40 1762. 2005) (Mir a Vista I-866-647-2847)

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Alternative: Csspotungin 70 mg IV on ilay I. Ilwn 50 mg IV g24h (reduce to 35 mg with moderale hepalic itisulfioencyl For all regimens !l response good may switch lo vori alter 2-3 wks (See provtous page) Mlcafungln"" i50mglVq24h

Itraconazole1 oral solution 200-400 nig pei day polot 6mos OR Ampho B'O 7-1 mg (.«el kg pei day lo a total dose ol ¿1 5 gm lot 'MY sick pis

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demonstrated vs a spot tall us in vitro 4/or animal models between tnozotes 4 caspo (AAC 47 I4Í6. 2003)4 ampho B plus caspo (AAC 46 245 4 2564. 2002. JID 187 1 834. 2003; Some failures to show synergy (JAC 56 166. 2005)

In retrospective evaluation ot bone matrow transplant pts wilh IPA who lailed ampho B. von 1 caspo superiot to von alono (CID 39 797. 2004)

Resistance A fumigalus isolates trom stem cell transplants showed Í suaceplitx-lity to vori, caspo. 4 some to ampho B

Blastomycosis (CID 30:679.2000) (Blastomyces dotmalilldis) Cutaneous, pulmonary or exti, Fi j blood/urine antigen, call 1

Fluconazole 400-800 nig )ier day lot at leasl6mos 85% i etloclive lot non-lile-thieateniiig disease (CID 25 200, 1997)

lira m patients Heated lor 22 months. 95% cure (AJM 93 48». I$92) Amplio B successful in -90% (CID 22.SÍ02. 1996) Von successlul m tx ol 1 pt with cerubral blastomyco sis (CID 40 e69. 2005)

Candidiasis A decrease in C albicans 4 increase iti non albicans speoes r.-rfllinuiis The latter show susceptibility to antifungal agents (esp tluconazolol These changes piedom.nanllyiriimmiini. compromised pis wiieiem antitungal piophyiaxis (esp lluconazole) is widely used (JCM 43 2729. 2005. CCHD 18 490, 2005; In vitro suscoplilxlity leslinqloi antitungal drugs tias nol undergone in vivo validation studies clinical outcomes olten mote dependent on host lactors (AJM 112 380. 2002) Susceptibility profiles holp select empiric antitiaigal rx The table summarizes curienl published leports ol frequency ol canctda isolates 4 mtertxetation as to whether a drug is dinically utlective IS - susceptible) 11 iay loqiate dose escalation (S-OD = auaceptlble with dose escalation) or is likely to be metier live (R = resistant) d o 359 1135. 2002) S-l = less activity in vitro but clinically effective only rare laiiures icported (IDSA Guidelines. 2004 CID 38 161. 2004) In vitro testing for caspo not standardized in clinical studies ol Candida inteclii < s MIC of caspo rtd not correiate with tioalmenl outcome followinq caspofunan therapy (AAC 49:3616. 2005)_ ____

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