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Uses

Aspergillosis

Treatment of pulmonary and extrapulmonary aspergillosis in patients intolerant of, or whose disease is refractory to, IV amphotericin B.

Amphotericin B generally is drug of choice for invasive aspergillosis, especially for life-threatening and severe infections; itraconazole is an alternative.

Basidiobolomycosis

Treatment of GI basidiobolomycosis†, a zygomycosis caused by Basidiobolus ranarum.

GI basidiobolomycosis has been successfully treated with oral itraconazole after partial surgical resection of the GI tract; unclear whether a clinical response would have been obtained if itraconazole had been used alone without surgical intervention.

Blastomycosis

Treatment of pulmonary and extrapulmonary blastomycosis caused by Blastomyces dermatitidis.

Both oral itraconazole and IV amphotericin B are drugs of choice for treatment of blastomycosis. Amphotericin B usually preferred for treatment of severe infections (especially those involving the CNS) and for initial treatment of presumptive blastomycosis in immunocompromised patients, including HIV-infected individuals. Itraconazole usually preferred for treatment of nonmeningeal, non-life-threatening blastomycosis (including mild to moderate disseminated infections without CNS involvement) and for follow-up in more severe infections after an initial response has been obtained with amphotericin B.

Candida Infections

Treatment of oropharyngeal and esophageal candidiasis.

Alternative to fluconazole for long-term suppressive or maintenance therapy (secondary prophylaxis)† to prevent recurrence or relapse of mucocutaneous candidiasis (esophageal, oropharyngeal, vaginal) in HIV-infected infants, children, adolescents, and adults. USPHS/IDSA states that secondary prophylaxis against mucocutaneous candidiasis should be considered only in those who have frequent or severe recurrences of these infections. Consider the impact of recurrences on the 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.

Coccidioidomycosis

Alternative for treatment of coccidioidomycosis†.

Alternative to fluconazole for long-term suppressive or maintenance therapy (secondary prophylaxis) to prevent recurrence or relapse of coccidioidomycosis in HIV-infected individuals†.

Chromomycosis

Treatment of chromomycosis† (chromoblastomycosis) caused by various dematiaceous fungi (e.g., Cladosporium, Exophiala, Fonsecaea, Phialophora).

Cryptococcosis

Alternative for treatment of cryptococcosis†.

Alternative to fluconazole for primary prophylaxis of cryptococcosis† 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).

Alternative to fluconazole for long-term suppressive or maintenance therapy (secondary prophylaxis) to prevent recurrence or relapse of cryptococcosis† in HIV-infected infants, children, adolescents, and adults.

Histoplasmosis

Treatment of histoplasmosis, including chronic cavitary pulmonary disease and disseminated nonmeningeal disease.

Both IV amphotericin B and oral itraconazole are drugs of choice for treatment of histoplasmosis. Amphotericin B generally is preferred for initial treatment of severe, life-threatening histoplasmosis (especially in immunocompromised patients such as those with HIV infection). Itraconazole generally is used for initial treatment of mild to moderate infections (e.g., in patients who do not require hospitalization) or as follow-up treatment of severe infections after a response has been obtained with amphotericin B.

Drug of choice for primary prophylaxis† against histoplasmosis in HIV-infected adults or adolescents with CD4⁺ T-cell counts <100/mm³ or HIV-infected infants and children with severe immunosuppression (as defined by age-adjusted criteria).

Drug of choice for long-term suppressive or chronic maintenance therapy (secondary prophylaxis)† to prevent recurrence in HIV-infected adults, adolescents, and pediatric patients who have documented, adequately treated histoplasmosis.

Onychomycosis

Treatment of onychomycosis of the toenails (with or without fingernail involvement) and onychomycosis of the fingernails caused by dermatophytes (tinea unguium).

Paracoccidioidomycosis

Treatment of paracoccidioidomycosis† (South American blastomycosis) caused by Paracoccidioides brasiliensis. A drug of choice.

Sporotrichosis

Treatment of sporotrichosis†.

IV amphotericin B is drug of choice for initial treatment of severe, life-threatening infections and whenever there is CNS involvement. Oral itraconazole generally is considered drug of choice for treatment of cutaneous, lymphocutaneous, or mild pulmonary or osteoarticular sporotrichosis and for follow-up treatment of severe infections after a response has been obtained with amphotericin B.

Empiric Therapy in Febrile Neutropenic Patients

Empiric therapy of presumed fungal infections in febrile neutropenic patients.