Recommendations for the Treatment of Histoplasmosis
| Type of Histoplasmosis | Treatment Recommendations | Comments |
|---|---|---|
| Acute pulmonary, moderate to severe illness with diffuse infiltrates and/or hypoxemia | Lipid AmB (3-5 mg/kg per day) ± glucocorticoids for 1-2 weeks; then itraconazole (200 mg bid) for 12 weeks. Monitor renal and hepatic function. | Pts with mild cases usually recover without therapy, but itraconazole should be considered if the pt's condition has not improved after 1 month. |
| Chronic/cavitary pulmonary | Itraconazole (200 mg qd or bid) for at least 12 months. Monitor hepatic function. | Continue treatment until radiographic findings show no further improvement. Monitor for relapse after treatment is stopped. |
| Progressive disseminated | Lipid AmB (3-5 mg/kg per day) for 1-2 weeks; then itraconazole (200 mg bid) for at least 12 months. Monitor renal and hepatic function. | Liposomal AmB is preferred, but the AmB lipid complex may be used because of cost. Chronic maintenance therapy may be necessary if the degree of immunosuppression cannot be reduced. |
| Central nervous system | Liposomal AmB (5 mg/kg per day) for 4-6 weeks; then itraconazole (200 mg bid or tid) for at least 12 months. Monitor renal and hepatic function. | A longer course of lipid AmB is recommended because of the high risk of relapse. Itraconazole should be continued until cerebrospinal fluid or CT abnormalities clear. |
Abbreviation: AmB, amphotericin B.