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. |