THE SANFORD GUIDETo Antimicrobial Therapy2022 02
underlying hematological malignancy. Mortality rates still high, particularly in those with concomitant pneumonia (Postgrad Med 121407,2009). Early Dx essential for improved outcome (PLOSMedicine 4:e47, 2007). • Ampho B + 5FCtreatment I crypto CFUsmore rapidly than ampho + Flu or Ampho + 5FC+ Flu. Ampho B 1 mg/kg/d alone much more rapidly fungicidal in vivo than Flu 400 mg/d (CID 45=76681,2007). Use of lipid-based Ampho B associated with lower mortality compared to Ampho B deoxycholate in solid organ transplant recipients (CID 484566, 2009). • Monitor 5-FClevels: peak 70-80 mg/L, trough 30-40 mg/L. Higher levels assoc, with bone marrow toxicity. No difference in outcome if given IV or po (AAC 51=1038,2007). • 5-FCis renally cleared therefore if renal failure occurs during treatment with Ampho B, 5-FCdose needs adjustment • Trend toward improved outcomes with fluconazole 400-800 mg combined with Ampho B versus Ampho B alone in AIDS patients (CID 484775, 2009). Role of other azoles unce