Treatment Recommendations of Bariola et al for a Patient with Blastomycosis in the Central Nervous System

 

General issues:

(1) Therapy should be started promptly once a diagnosis has been made.

(2) If the patient has an immunocompromising condition then it should be addressed if possible.

(3) The patient should be monitored closely during therapy to ensure compliance, to document response to therapy and to detect signs of toxicity.

 

Antifungal therapy:

(1) Therapy typically starts with parenteral administration of a lipid formulation of amphotericin B. Guidelines recommend therapy for 4 to 6 weeks but many physicians will switch to oral therapy after 2 weeks of amphotericin.

(2) The patient is then started on oral azole therapy for 1 year after the course of amphotericin has been completed.

(2a) Voriconazole is preferred.

(2b) Alternative drugs are fluconazole or itraconazole.

(2c) Serum azole concentrations should be monitored.