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Uses

Blastomycosis

Treatment of North American blastomycosis† caused by Blastomyces dermatitidis.

Drug of choice is IV amphotericin B (especially for severe infections and those involving the CNS) or oral itraconazole; fluconazole is an alternative.

Candida Infections

Treatment of oropharyngeal and/or esophageal candidiasis in immunocompromised adults with HIV infection, malignancy, or other serious underlying disease. A drug of choice.

Long-term suppressive or maintenance therapy (secondary prophylaxis) to prevent recurrence or relapse of mucocutaneous candidiasis† (e.g., oropharyngeal, esophageal candidiasis, vaginal) in HIV-infected infants, children, adolescents, or adults. USPHS/IDSA states such secondary prophylaxis should be considered only in those with frequent or severe recurrences, taking into consideration the impact of recurrences on patient’s well-being and quality of life, need for prophylaxis against other fungal infections, cost, drug toxicities, drug interactions, and potential for development of azole resistance in Candida and other fungi. When indicated, drug of choice is fluconazole and alternative is itraconazole.

Treatment of uncomplicated or complicated vulvovaginal candidiasis. CDC and others recommend that uncomplicated vulvovaginal candidiasis (mild to moderate, sporadic or infrequent, most likely caused by Candida albicans, occurring in immunocompetent women) be treated with an intravaginal azole antifungal (e.g., butoconazole, clotrimazole, miconazole, terconazole, tioconazole) or, alternatively, oral fluconazole. Single-dose oral fluconazole regimen offers some advantages over topical agents (e.g., ensures compliance, may reduce or eliminate concurrent rectal infections that can be source of reinfection), but may be associated with an increased risk of adverse effects.

Treatment of disseminated or invasive Candida infections, including urinary tract infections, peritonitis, pneumonia, candidemia, chronic disseminated candidiasis (hepatosplenic candidiasis), endocarditis, meningitis, and osteomyelitis. A drug of choice. Amphotericin B generally preferred for severe candidemia when infection is caused by strains that may be fluconazole-resistant (e.g., C. krusei, C. glabrata) and for patients who recently received fluconazole or are immunocompromised (e.g., those with HIV); fluconazole may be preferred in infections caused by C. lusitaniae.

Prevention of candidiasis in bone marrow transplant (BMT) recipients who are receiving chemotherapy or radiation therapy.

Coccidioidomycosis

Treatment of coccidioidomycosis† caused by Coccidioides immitis (e.g., meningitis, pulmonary infections, disseminated infections including soft tissue or bone and joint). A drug of choice, especially for coccidioidal meningitis.

Long-term suppressive or maintenance therapy (secondary prophylaxis) to prevent recurrence or relapse of coccidioidomycosis† in HIV-infected children, adolescents, and adults. USPHS/IDSA recommends oral fluconazole as the drug of choice and IV amphotericin B and oral itraconazole as alternatives.

Cryptococcal Infections

Treatment of meningitis caused by Cryptococcus neoformans.

Amphotericin B (with or without concomitant flucytosine) usually considered regimen of choice for initial treatment of cryptococcal meningitis; fluconazole is an alternative for patients whose disease is not severe and for follow-up after an initial amphotericin B regimen.

Prevention of cryptococcosis† (primary prophylaxis) in HIV-infected adults and adolescents with CD4⁺ T-cell counts <50/mm³ and in infants and children with severe immunosuppression (as defined by age-adjusted criteria). USPHS/IDSA recommends fluconazole as drug of choice and itraconazole as alternative for primary prophylaxis.

Long-term suppressive or maintenance therapy (secondary prophylaxis) to prevent recurrence or relapse of cryptococcosis† in HIV-infected children, adolescents, or adults. USPHS/IDSA and others recommend oral fluconazole as drug of choice and IV amphotericin B and oral itraconazole as alternatives.

Dermatophytoses

Treatment of certain dermatophytoses† (e.g., tinea capitis, tinea corporis, tinea cruris, tinea pedis) caused by Epidermophyton, Microsporum, or Trichophyton.

Has been used for treatment of onychomycosis† of the toenail. Drug of choice is oral terbinafine or oral itraconazole; oral fluconazole is an alternative and may be less effective than oral itraconazole or oral terbinafine.

Histoplasmosis

Treatment of histoplasmosis† caused by Histoplasma capsulatum.

Drug of choice is IV amphotericin B or oral itraconazole; oral fluconazole is an alternative.

Sporotrichosis

Treatment of sporotrichosis† caused by Sporothrix schenckii.

Drug of choice usually is IV amphotericin B, especially for initial treatment of severe, life-threatening infections and whenever there is CNS involvement; oral itraconazole is considered the drug of choice for treatment of cutaneous, lymphocutaneous, or mild pulmonary or osteoarticular sporotrichosis and for follow-up therapy in more severe infections after a response has been obtained with IV amphotericin B.

Fluconazole is considered a second-line agent for treatment of cutaneous, lymphocutaneous, or osteoarticular sporotrichosis since it may be less effective than itraconazole.

Prevention of Fungal Infections in Transplant or Cancer Patients

Prevention of fungal infections in patients undergoing BMT or solid organ transplantation† who are receiving chemotherapy or radiation therapy.