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5.3 Fungal infection

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only 
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

 

Antifungals

Echinocandin antifungals

 

Caspofungin 

  • Cancidas® Intravenous Infusion, powder for reconstitution, 50mg, 70mg vials

 

 

Micafungin sodium  

  • Mycamine® Intravenous Infusion, powder for reconstitution, 50mg, 100mg vials

 

 

Polyene antifungals    

 

Amphotericin (non-lipid)  

  • Fungizone® Intravenous Infusion, powder for reconstitution, 50mg vials

 

 

Amphotericin  (liposomal)   

  • AmBisome® Intravenous Infusion, powder for reconstitution, 50mg vials

Notes:

  • Liposomal amphotericin is reserved only for patients where toxicity is a problem. 
  • Fungizone® should be used first line in most patients.

 

Advice for healthcare professionals:

• when prescribing, communicating and dispensing amphotericin products, use both the complete generic name and the proprietary name:

o non-lipid amphotericin (Fungizone)

o liposomal amphotericin (AmBisome)

o lipid-complex amphotericin (Abelcet)

• verify the product name and dose before administration, especially if the dose prescribed exceeds 1·5 mg/kg—the maximum recommended dose for Fungizone.

• report suspected adverse reactions associated with amphotericin B, including medication error with associated harm to patients, on a Yellow Card

 

 

Triazole antifungals    

 

Fluconazole    

  • Capsules 50mg, 150mg, 200mg
  • Oral suspension 10mg/1mL, 40mg/1mL
  • Infusion 200mg/100mL (Hospital only)

 

 

Itraconazole (Amber 2)

  • Capsules 100mg
  • Oral suspension 10mg per 1mL sugar free (Hospital Only)

Notes:

  1. Itraconazole is for the treatment of Aspergillosis only.
  2. Itraconazole has been associated with liver damage and should not be given to patients with a history of liver disease.
  3. CSM advice - heart failure: Following rare reports of heart failure, the CSM has advised caution when prescribing itraconazole to patients at high risk of heart failure. Those at risk include:
  • Patient receiving high doses and longer treatment courses
  • Older patients and those with cardiac disease
  • Patients receiving treatment with negative inotropic drugs, eg. calcium channel blockers.

 

 

Posaconazole   

  • Noxafil® Tablets Gastro-resistant 100mg 
  • Noxafil® Oral suspension 40mg per 1mL  

Notes:

 

 

Voriconazole 

  • Tablets 50mg, 200mg
  • Intravenous Infusion 200mg

 

 

5.3.1 Pneumocystis pneumonia

Pneumonia caused by Pneumocystis jirovecii (Pneumocystis carinii) occurs in immunosuppressed patients; it is a common cause of pneumonia in AIDS.  Pneumocystis pneumonia should generally be treated by those experianced in its management.  Blood gas measurement is used to assess severity.

Treatment 

Co-trimoxazole (Restricted, Amber 2) 

(Trimethoprim plus sulfamethoxazole)

 

 

Pentamidine isetionate 

  • Intravenous Infusion, powder for reconstitution, 300mg vials
  • Nebuliser solution 300mg

 

 

Prophylaxis 

Co-trimoxazole (Restricted, Amber 2) 

(Trimethoprim plus sulfamethoxazole)

 

 

Dapsone (Amber 3)

  •  Tablets 50mg, 100mg

Note:

  • For long-term treatment, patients and their carers should be told how to recognise the signs of blood disorders and advised to seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop.

 

 

Clindamycin 

  • Capsules 150mg
  • Injection 300mg/2mL, 600mg/4mL

Notes:

  • Clindamycin’s principal indication is second line for gram-positive soft tissue, bone and joint infections.
  • It is associated with Clostridium difficile diarrhoea, which limits its use.
  • Patients should discontinue treatment immediately if diarrhoea develops

 

 

Primaquine (Unlicensed)

  • Tablets 7.5mg

 

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Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only 
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

 

 

 

 

 

Return to Chapter: 5. Infections

Last updated by: Dupe Fagbenro on 20-02-2019 16:35