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P A R T 2
Chemotherapeutic agents
TABLE 11.1
DRUGS IN FOCUS Systemic antifungals
Drug name
Dosage/route
Usual indications
Azole antifungals
fluconazole
(Canesoral, Diflucan,
Dizole)
Adult: 200–400 mg PO on day one, followed
by 100 mg/day PO; IV route can be used, but
do not exceed 200 mg/hour
Paediatric: 3–6 mg/kg PO; do not exceed
12 mg/kg
Treatment of candidiasis, cryptococcal
meningitis, other systemic fungal
infections; prophylaxis for reducing the
incidence of candidiasis in bone marrow
transplant recipients
itraconazole (Sporanox)
Adult: 100–400 mg/day PO
Paediatric: safety and efficacy not established
Treatment of blastomycosis,
histoplasmosis and aspergillosis
ketoconazole (Nizoral)
Adult: 200 mg/day PO, up to 400 mg/day PO in
severe cases
Topical: as a shampoo and topical
Treatment of aspergillosis, leishmaniasis,
cryptococcosis, blastomycosis,
moniliasis, coccidioidomycosis,
histoplasmosis and mucormycosis;
topical treatment of mycoses (cream)
and to reduce the scaling of dandruff
(shampoo)
posaconazole (Noxafil)
Adults and children ≥13 years: 200 mg PO
t.d.s. with food
Prophylaxis of invasive Aspergillus and
Candida infections in adults and children
>13 years who are immunosuppressed
secondary to antineoplastic,
chemotherapy, graft-versus-host disease
following transplants or haematological
malignancies
terbinafine (Lamisil,
Tamsil)
250 mg/d PO for 6 weeks (fingernail) or
12 weeks (toenail)
Treatment of onychomycosis of
the fingernail or toenail caused by
dermatophytes; the drug was approved
in late 2007 for treatment of tinea capitis
(ringworm of the scalp) in children
≥4 years
voriconazole (Vfend)
Adult: 6 mg/kg IV q 12 hours for two doses,
then 4 mg/kg IV q 12 hours; switch to oral
dose as soon as possible
>40 kg: 200 mg PO q 12 hours
<40 kg: 100 mg PO q 12 hours
Treatment of invasive aspergillosis;
treatment of serious fungal infections
caused by Scedosporium apiospermum
or Fusarium species when the person is
intolerant to or not responding to other
therapy
Echinocandin antifungals
anidulafungin (Eraxis)
100–200 mg IV on day one, then 50–100 mg/
day IV for 14 days; dose varies with infection
being treated
Treatment of candidaemia (infection of the
blood stream) and other forms of Candida
infection, intraabdominal infections and
oesophageal candidiasis
caspofungin acetate
(Cancidas)
Adult: 70 mg/day IV loading dose, then 50 mg/
day IV infusion; dose should be reduced
to 35 mg/day IV infusion with hepatic
impairment
Treatment of invasive aspergillosis in
people who do not respond or are
intolerant to other therapies
Other antifungals
amphotericin B (Abelcet,
AmBisome, Fungilin)
0.25–1.5 mg/kg per day IV based on the
infection being treated
Treatment of aspergillosis, leishmaniasis,
cryptococcosis, blastomycosis,
moniliasis, coccidioidomycosis,
histoplasmosis and mucormycosis; use
is reserved for progressive, potential
fatal infections due to many associated
adverse effects
flucytosine (Ancotil)
Adult: 37.5–50 mg/kg IV over 20–40 mins q
6 hours
Treatment of systemic infections caused
by Candida or Cryptococcus
