Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

• Cisapride (contraindicated) • Voriconazole• Diltiazem• DolasetronErythromycin disrupts the gut flora, biliary excretion and/or inhibits P-glycoprotein, which may alter the absorption ormetabolism of:• Carbidopa/levodopa• Digoxin• Estrogens• Oral contraceptivesETRAVIRINE (Intelence ® ) – non-formulary at UWHCFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/FLUCONAZOLEUsual DoseAdult: Treatment 400-800 mg on day 1, then 200-400 mg daily IV/PO (UWHC cost/day IV $2.68-5.37; PO $0.14-0.28)Prophylaxis 50-100 mg daily PO (UWHC cost/day $0.07-0.08).Pediatrics:** 3-12 mg/kg/day PO/ IV.Pediatric Prophylaxis 5 mg/kg/day (not to exceed 400 mg/day)Recommended Fluconazole DosesFor Prevention and Treatment of Candida albicans InfectionsInfection Site Route Adult Dose Pediatric Dose*Bloodstream IV/PO 400 mg/day 6 mg/kg/dayLung IV/PO 400 mg/day 6 mg/kg/dayAbdomen IV/PO 400 mg/day 6 mg/kg/dayOropharynx PO 100 mg/day 3 mg/kg/dayUrinary tract**(cystitis)PO 200 mg/day 3 mg/kg/dayUrinary tract(pyelonephritis)IV/PO 400 mg/day 6 mg/kg/dayNeutropenicprophylaxisIV/PO 400 mg/day 6 mg/kg/day*Use loading dose of twice this amount for initial dose; pediatric dose should not exceed adult dose**Asymptomatic candiduria should not be treatedIndications1. Oropharyngeal candidiasis when topical antifungal therapy is ineffective and esophageal candidiasis (200-400 mgdaily).2. Deep candidal infections, non-CNS cryptococcal infections, with demonstrated susceptibility to fluconazole ordocumented response to therapy. CAUTION: Fluconazole failures have been reported in fungal infections causedby C krusei and some C glabrata; thus, fluconazole is NOT recommended as first-line therapy for theseorganisms when there is a serious infection. Isolates of these organisms from sterile body sites are sent automaticallyby the microbiology lab for susceptibility testing for fluconazole. Verify testing is being performed with the microbiology labin critical isolates.3. Cryptococcal meningitis, in patients with AIDS, as a step-down from IV amphotericin B or as an alternative in patientsintolerant of or unresponsive to amphotericin B.4. For indefinite suppression of Cryptococcus neoformans infections in AIDS or other immunocompromised patients (200mg once daily).5. Non-life-threatening infections with Histoplasma capsulatum, Blastomyces dermatitidis and Coccidioides immitis.Itraconazole appears to be more effective in vitro and clinically. Chemotherapy 1992;38 Suppl 1:3-11.