"Antibiotics" - Fungal

Infection

Oropharyngeal thrush

Nystatin suspension 1ml q6h po.

7 days, or continue for 48hrs after lesions have resolved.

If severe,add Fluconazole 50-100mg q24h po for 7-14 days.

Infection

Vaginal thrush

Clotrimazole pessary 500mg pv stat.

Add clotrimazole 2% cream if vulvitis present.

Add Fuconazole 150mg po stat if severe or not responding to Clotrimazole pessary.

Infection

Fungal skin infection

Clotrimazole % cream q12h to affected areas
or
Terbinafine cream: Apply 1-2 times a day for up to 1-2 weeks, to be applied thinly. Review treatment after 2 weeks.

Continue for 1-2 weeks after disappearance of signs of infection.

Consider oral therapy with Fluconazole 50mq 24h for 2-4 weeks if infection widespread, disseminated or intractable.

If in doubt of diagnosis, skin scrapings should be examined.

Infection

Fungal nail infection

Terbinafine 250mg q24h po

6 - 12 weeks (occasionally longer in toenails).

↓ dose in renal impairment and avoid in hepatic impairment.

Infection

Candidaemia or suspected invasive candidiasis

Always seek advice from Microbiology or ID.

Caspofungin 70mg iv stat then 50mg iv q24h (70mg iv q24h if >80kg).

Confirmed candidaemia: treat for 14 days after first negative blood culture and resolution of signs and symptoms of candidaemia.

Always seek advice from microbiology.

If C. albicans isolated change to Fluconazole 800mg stat iv then 400mg q24h iv, and consider oral switch when there is clinical improvement.

Ophthalmological examination recommended in all patients with candidaemia.

Infection

Aspergillosis

Always seek advice from microbiology/ID

Always seek advice from microbiology/ID

Infection

Immunocompromised patients

Various.

Always seek advice from microbiology/ID.

Always seek advice from microbiology/ID.