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Antimicrobials
Empirical antifungal therapy should be considered in high risk patients who are experiencing persistent fevers and no identified source after receiving 4-7 days of broad-spectrum antibiotic therapy. The choice of empiric antifungal therapy depends upon likely fungal pathogens, toxicities and cost.
If patient has not received antifungal prophylaxis, then candida infection is initially of greatest concern.
If patient receiving fluconazole prophylaxis, fluconazole resistant candida infections or an invasive mold infection more likely. Switch to an IV anti-mold agent within a different class.
Amphotericin B IV
Dose 0.5-1 mg/kg IV daily
Cost/Day $100
Comments Use in combination with aminoglycosides and/or vancomycin with extreme caution due to additive renal toxicities.
Fluconazole PO/IV
Dose 800 mg IV/PO daily
Cost/Day PO: $1 IV: $10-15
Comments Use only if patient has not received azole prophylaxis and is at low risk of invasive aspergillus infection.
Voriconazole PO/IV
Dose 6 mg/kg IV/PO q12h x 2 doses, then 4 mg/kg IV/PO x 2 doses for invasive aspergilosis
Cost/Day PO: $4 IV: $120-150
Comments Use only if patient has not received azole prophylaxis or is at high risk for invasive aspergillus.
Caspofungin IV
Dose 70 mg IV on Day 1, then 50 mg IV daily
Cost/Day $150
