From the Guidelines
For the treatment of histoplasmosis, itraconazole is the recommended antifungal therapy for mild to moderate disease, while liposomal amphotericin B is recommended for severe or life-threatening infections, followed by step-down therapy to itraconazole. The treatment approach depends on the severity of the disease and the patient's immune status.
Treatment Approach
- For mild to moderate disease, itraconazole is given at 200 mg three times daily for 3 days as a loading dose, then 200 mg twice daily for at least 12 months 1.
- For severe or life-threatening infections, liposomal amphotericin B is recommended at 3-5 mg/kg/day intravenously for 1-2 weeks, followed by step-down therapy to itraconazole for a total treatment duration of at least 12 months 1.
- Fluconazole 800 mg daily can be used as an alternative if itraconazole is not tolerated, though it's less effective 1.
Key Considerations
- Therapeutic drug monitoring is important for azole therapy to ensure adequate blood levels 1.
- Treatment duration may be extended in immunocompromised patients, and maintenance therapy might be needed for those with AIDS until immune reconstitution occurs 1.
- The choice of antifungal therapy should be based on the severity of the disease, the patient's immune status, and the potential for drug interactions and side effects 1.
Monitoring and Adjustments
- Blood levels of itraconazole should be obtained to ensure adequate drug exposure 1.
- Antigen levels should be measured during therapy and for 12 months after therapy is ended to monitor for relapse 1.
- The treatment approach may need to be adjusted based on the patient's response to therapy and the presence of any adverse effects 1.
From the FDA Drug Label
Amphotericin B for Injection USP is specifically intended to treat potentially life-threatening fungal infections: ... histoplasmosis... The recommended antibiotic for treating histoplasmosis is amphotericin B (IV) 2.
- Key points:
- Amphotericin B is used for potentially life-threatening fungal infections
- Histoplasmosis is one of the fungal infections that amphotericin B is intended to treat
From the Research
Treatment Options for Histoplasmosis
The recommended treatment for histoplasmosis depends on the severity of the disease.
- For moderate to severe and disseminated presentations, amphotericin B is the drug of choice 3, 4, 5, 6.
- For mild disease, itraconazole is appropriate 3, 4, 5, 6.
- Itraconazole can also be used as step-down therapy after initial treatment with amphotericin B 3, 6.
- Posaconazole may be a useful salvage treatment option for histoplasmosis involving a variety of infected tissues and organs 7.
Specific Treatment Recommendations
- Amphotericin B or one of its lipid formulations is recommended as initial treatment in patients with more extensive diseases, felt to be ill enough to require hospitalization 3.
- Itraconazole is recommended for those who have milder illness, or to complete treatment after patients respond to amphotericin B 3.
- Fluconazole therapy for histoplasmosis is only moderately effective 5.