What is the treatment for a patient with neutropenia and a fungal urinary tract infection caused by Magnusiomyces (formerly known as Magnusiomycetes) clavatus?

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From the FDA Drug Label

İdrarda nötroprnik hastada Magnusiomyces clavatus enfeksiyonu için tedaviye ilişkin bilgi bulunmamaktadır.

The FDA drug label does not answer the question.

From the Research

İdrarda nötrofilik hastada Magnusiomyces clavatus enfeksiyonu tedavisi genellikle vorikonazol veya pozakonazol ile sistemik antifungal tedaviyi içerir. Vorikonazol, 1 çalışmasında Magnusiomyces clavatus'a karşı en yüksek in vitro antifungal aktiviteyi göstermiştir. Tedaviye vorikonazol ile başlamak ve ardından klinik düzelme sonrası oral fluconazole ile devam etmek önerilir. İdrar yolundaki kateterlerin çıkarılması da önemlidir, çünkü bu cihazlarda biyofilmler oluşabilir. Altta yatan nötrofiliyi ele almak da kritiktir, bu da granülosit koloni stimülasyon faktörü (G-CSF) uygulamasını içerebilir. Magnusiomyces clavatus, özellikle nötrofilik hastaları etkileyen bir oportunistik fungal patojendir ve bu enfeksiyonlar bağışıklık sistemi iyileşmeden eradike edilemeyebilir, bu nedenle agresif antifungal tedavi ile nötrofili yönetimini birleştirmek en iyi tedavi şansı sunar.

Tedavi seçenekleri şunları içerebilir:

  • Vorikonazol: 400-800 mg/gün oral veya intravenöz
  • Pozakonazol: 400-800 mg/gün oral veya intravenöz
  • Amfoterisin B: 0,6-1 mg/kg/gün intravenöz, ancak 1 çalışmasında Magnusiomyces clavatus'a karşı daha düşük in vitro antifungal aktivite göstermiştir.

Tedavi süresi, klinik yanıt ve nötrofili düzelmesine bağlı olarak 14-21 gün arasında değişebilir.

References

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