From the Guidelines
For an abscess growing mold, empiric antifungal treatment should begin with voriconazole as first-line therapy, typically dosed at 6 mg/kg IV every 12 hours for two doses, followed by 4 mg/kg IV every 12 hours, or 200-300 mg orally twice daily. This recommendation is based on the most recent and highest quality study available, which is the 2016 update by the Infectious Diseases Society of America for the diagnosis and management of aspergillosis 1.
Key Considerations
- Alternative options include liposomal amphotericin B (3-5 mg/kg/day IV) or isavuconazole (200 mg IV/oral every 8 hours for 6 doses, then 200 mg daily) as outlined in the guidelines for empiric antifungal therapy 1.
- Treatment duration typically ranges from 6-12 weeks depending on clinical response, with surgical debridement strongly recommended whenever possible as an adjunct to antifungal therapy.
- It's essential to obtain fungal cultures and susceptibility testing to guide definitive therapy, as some molds may have resistance patterns requiring adjustment of the antifungal regimen.
Monitoring and Safety
- Monitor for drug-specific toxicities including hepatotoxicity with azoles and nephrotoxicity with amphotericin B, with regular liver function tests, renal function tests, and therapeutic drug monitoring for voriconazole 1.
- The choice of antifungal agent should be guided by the specific type of mold isolated, the patient's clinical condition, and potential drug interactions, as discussed in the guidelines for the treatment of aspergillosis 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Empiric Antifungal Treatment for Abscess Growing Mold
The empiric antifungal treatment for an abscess growing mold is typically based on the severity of the infection and the suspected causative organism.
- Liposomal amphotericin B is a broad-spectrum antifungal agent that is active against various molds, including Aspergillus spp. and filamentous molds such as Zygomycetes 2.
- Posaconazole, voriconazole, and ravuconazole are new triazole derivatives that have shown potent activity against a wide range of filamentous fungi, including Aspergillus spp. 3, 4, 5.
- Caspofungin is an echinocandin antifungal agent that has demonstrated excellent in vitro activity against Aspergillus spp. and some other filamentous fungi 5.
- Voriconazole is a broad-spectrum azole antifungal agent that has shown in vitro and in vivo activity against a variety of molds, including Aspergillus spp. 6.
Treatment Options
- Liposomal amphotericin B is approved for the treatment of invasive fungal infections, including those caused by molds 2.
- Posaconazole, voriconazole, and ravuconazole have shown promising activity against molds, but their clinical use may be limited by factors such as toxicity and drug interactions 3, 4, 5.
- Caspofungin and other echinocandin antifungal agents may be used as alternative or adjunctive therapy for invasive mold infections 5, 6.
- Combination therapy with multiple antifungal agents may be considered in severe or refractory cases of invasive mold infections 6.