| Antifungal Agent or Adjunctive Therapy | Dosage Range in Adult Patients* | Dosage in Pediatric Patients* | Toxicity | Comments |
|---|---|---|---|---|
| Posaconazole | 400 mg PO Q12h 200 mg PO Q6h | Investigational | Hepatotoxicity Nausea, vomiting, diarrhea | Used as single agent; no evidence for synergy in combination with amphotericin B |
| Echinocandins | ||||
| Caspofungin | 70 mg IV loading dose followed by 50 mg/d IV | 50 mg/m2/day IV | Hepatotoxicity | Used only in combination with amphotericin B Adjustment in dosage for liver dysfunction |
| Micafungin | 100 mg/d IV | 4 mg/kg/day IV | Hepatotoxicity | Used only in combination with amphotericin B Adjustment in dosage for liver dysfunction |
| Anidulafungin | 100 mg/d IV | 1.5 mg/kg/d IV | Hepatotoxicity | Used only in combination with amphotericin B No adjustment in dosage needed for liver dysfunction |
| Posaconazole | 400 mg PO Q12h 200 mg PO Q6h | Investigational | -Hepatotoxicity
-GI symptoms: nausea, vomiting, and diarrhea |
Used as single agent; no evidence for synergy in combination with amphotericin B |
| Echinocandins | ||||
| Caspofungin | 70 mg IV loading dose followed by 50 mg/d IV | 50 mg/m2/day IV | -Hepatotoxicity -Infusion-related toxicity | Used only in combination with amphotericin B
Adjustment in dosage for liver dysfunction |
| Micafungin | 100 mg/d IV | 4 mg/kg/day IV | -Hepatotoxicity -Infusion-related toxicity | Used only in combination with amphotericin B
Adjustment in dosage for liver dysfunction |
| Deferasirox (Exjade®) | 20 mg/kg/day PO for 2 to 4 weeks | Investigational | -Nephrotoxicity
-GI symptoms: nausea and diarrhea |
Used only in combination with lipid formulation of amphotericin B |
| Recombinant cytokines:
G-CSF, GM-CSF |
G-CSF 5 µg/kg/day SQ or IV
GM-CSF 100 to 250 µg/m2 |
G-CSF 5 µg/kg/day SQ or IV
GM-CSF 100 to 250 µg/m2 SQ |
Bone pain and arthralgias | GCSF or GMCSF in neutropenic hosts;
GM-CSF in non-neutropenic hosts (see text more details) |
| Granulocyte Transfusions | Approximately ~109 cells/kg | Approximately ~109 cells/kg | -Infusion-related toxicity
-Respiratory distress -Alloimmunization |
Indicated for persistently neutropenic patients with documented refractory infection |
| Hyberbaric oxygen | Refer to comments | Refer to comments | Pressures and duration for management of mucormycosis are not standardized. Management is individualized. |
*Optimal dosage and duration of antifungal therapy for mucormycosis is not well defined.