Fungal sinusitis
- In immunocompetent host, fungi in sinuses may be associated with nasal polyposis and do not routinely require antifungal therapy.
- In immunocompromised patients/diabetic ketoacidosis, a fungal infection can present as a cellulitis that may rapidly progress and be fatal. Surgical debridement is necessary.
Usual Pathogens
Aspergillus spp
Rhizopus spp
Mucor spp
Immunocompetent
Empiric Therapy | Dose | Duration |
---|---|---|
Antifungal therapy not routinely recommended |
Immunocompromised / diabetic ketoacidosis
Aspergillus
Empiric Therapy | Dose | Duration |
---|---|---|
Voriconazole | 6mg/kg IV q12h first day then 4mg/kg IV q12h or 200mg PO bid | Until clinical and radiographic resolution and reversal of immunosuppression, if possible. Suppressive therapy then usually continued for at least 3-6 months, or life-long if continuing immunosuppression. |
or | ||
Amphotericin B | 1-1.25mg/kg IV daily | Until clinical and radiographic resolution and reversal of immunosuppression, if possible. Suppressive therapy then usually continued for at least 3-6 months, or life-long if continuing immunosuppression. |
Rhizopus/Mucor
Empiric Therapy | Dose | Duration |
---|---|---|
Amphotericin B | 1-1.5mg/kg IV daily | Until clinical and radiographic resolution and reversal of immunosuppression, if possible. Suppressive therapy then usually continued for at least 3-6 months, or life-long if continuing immunosuppression. |
Alternative
Empiric Therapy | Dose | Duration |
---|---|---|
Posaconazole | 400mg PO bid | Until clinical and radiographic resolution and reversal of immunosuppression, if possible. Suppressive therapy then usually continued for at least 3-6 months, or life-long if continuing immunosuppression. |