|
Drugs
|
Dosage
|
Adverse Effects
|
Remarks
|
|
Amphotericin B
|
0.7-1.5 mg/kg/day IV OD for acute therapy (2 weeks of induction phase)
|
Nephrotoxicity, fever, nausea, vomiting, hepatotoxicity, anemia, neurotoxicity, hyperkalemia
|
Nephrotoxicity is related to cumulative dose
|
|
Flucytosine
|
100 mg/kg/day PO in 4 divided doses (2 weeks of induction phase)
|
Bone marrow suppression, Hepatotoxicity, GI upset, Renal and skin toxicity
|
Should be avoided in children with severe renal involvement. TDM levels should be between 40-60 µg/ml.
|
|
Fluconazole
|
10-12 mg/kg/day PO/IV BD (max: 800 mg/day) [8-10 weeks of consolidation phase]. 3-6 mg/kg/day PO (max:200 mg) [Secondary prophylaxis].
|
Skin rash, pruritis, Stevens Johnson syndrome, Hepatitis, alopecia in scalp & public area
|
Inhibits P-450 cytochrome and thus adjustment with antiretroviral therapy is required.
|
|
Itraconazole
|
2-5 mg/kg/day PO BD [Consolidation phase - 8 weeks]
|
Skin rash, pruritis, Thrombocytopenia, Leukopenia, hepatitis, GI upset
|
Inhibits P450 cytochrome enzyme and thus has drug interactions with antiretroviral agents.
|
|
Liposomal Amphotericin B
|
3-5 mg/kg/day IV OD [Induction phase - 2 weeks]
|
Acute infusion related reactions such as chest pain, dyspnea, hypoxia, abdominal pain, flushing and urticaria.
|
Can be used instead of Amphotericin B in patients with renal insufficiency or infusion related toxicity to Amphotericin B.
|
Induction phase : Amphotericin B + Flucytosine for 2 weeks
OR
· Amphotericin B for 2 weeks
OR
Liposomal Amphotericin B + Flucytosine for 2 weeks
OR
Liposomal Amphotericin B fro 2 weeks
Alternative :
Fluconazole + Flucytosine [Not enough data in children]
Consolidation phase :
Fluconazole for 8 – 10 weeks
OR
Itraconazole for 2 weeks