Fungal disease	Drug and dosage
Invasive candidiasis
Uncomplicated fungemia	Amphotericin B desoxycholate (D-AmB), 0.5 - 1 mg/kg/d Fluconazole,*† 400 - 800 mg/d
Acute single site or disseminated    candidiasis ± fungemia	D-AmB, 0.5 - 1 mg/kg/d ± 5-fluorocytosine (5-FC),‡ 100 mg/kg/d Fluconazole,*† 400 - 800 mg/d Amphotericin B lipid formulations, 5 mg/kg/d starting dosage Echinocandin-lipopeptides (investigational) Second-generation triazoles (investigational)
Trichosporon and Blastoschizomyces infection	Fluconazole,* 400 - 800 mg/d ± D-AmB, >/= 1 mg/kg/d Second-generation triazoles (investigational)
Cryptococcosis	D-AmB, 0.7 mg/kg/d + 5-FC,‡ 100 mg/kg/d for a minimum of 2 weeks (induction), followed in stable patients by fluconazole,* 400 mg/d, for consolidation and maintenance Liposomal amphotericin B, 5 mg/kg/d§
Other rare yeast infections (eg, Rhodotorula rubra, Hansenula anomala, Saccharomyces cerevisiae)	D-AmB, 0.5 - 1 mg/kg/d ± 5-FC,‡ 100 mg/kg/d Fluconazole,*† 400 - 800 mg/d

*Loading dose: twice the target dose on the first day of treatment. Dosage adjustment may be required with reduced creatinine clearance and high dosages.
^†Only for identified and in vitro-susceptible isolates.
^‡Monitoring of serum levels required (< 100 µg/mL; target, 40 - 60 µg/mL). Dosage adjustment with reduced creatinine clearance.
^§For patients who cannot tolerate D-AmB or who have infections refractory to D-AmB.

Causative organism	Chemotherapy
Aspergillus fumigatus Aspergillus flavus Aspergillus niger Aspergillus terreus	Amphotericin B desoxycholate (D-AmB), 1 - 1.5 mg/kg/d Voriconazole,* 4 mg/kg bid Amphotericin B lipid formulations,† 5 mg/kg/d starting dosage Itraconazole,‡§ 200 - 600 mg/d Caspofungin,|| 50 mg/d Second-generation antifungal triazoles (investigational)
Fusarium solani Fusarium oxysporum Fusarium moniliforme Acremonium species Paecilomyces lilacinus Paecilomyces variotii Pseudallescheria boydii Scedosporium apiospermum Scedosporium prolificans	D-AmB, 1 - 1.5 mg/kg/d Amphotericin B lipid formulations,† 5 mg/kg/d starting dosage Itraconazole,§ 200 - 600 mg/d (only for second-line therapy for P variotii, P boydii, and S apiospermum infections) Second-generation antifungal triazoles (investigational) S prolificans: consider high-dose lipid-based amphotericin B or combination of itraconazole and terbinafine
Pigmented molds    Bipolaris    Exophiala    Alternaria and others	D-AmB, 1 - 1.5 mg/kg/d ± 5-fluorocytosine,¶ 100 mg/kg/d or Lipid formulations of amphotericin B,† 5 mg/kg/d starting dosage or Itraconazole,§ 200 - 600 mg/d or Second-generation antifungal triazoles (investigational)
Zygomycetes    Rhizopus species    Mucor species    Absidia species	D-AmB, 1 - 1.5 mg/kg/d Lipid formulations of amphotericin B,† 5 mg/kg/d starting dosage
Endemic molds    Histoplasma capsulatum    Blastomyces dermatitidis    Coccidioides immitis	D-AmB, 0.5 - 1 mg/kg/d Itraconazole,‡§ 200 - 400 mg/d, for H capsulatum and B dermatitidis Fluconazole,# 400 - 800 mg/d, for C immitis

*A recently published, open, randomized trial has demonstrated superior response rates and improved survival at week 12 of therapy with voriconazole (6 mg/kg IV for 2 doses, followed by 4 mg/kg IV q12h with option to switch to 200 mg PO bid) in comparison with D-AmB (1 mg/kg/d). Approval of this indication by the FDA was pending at the time of the preparation of this article.
^†For patients who cannot tolerate or who have infections refractory to D-AmB.
^‡For maintenance in stable patients.
^§Monitoring of serum levels recommended (> 0.5 µg/mL [high-performance liquid chromatography] or > 2 µg/mL [bioassay] at trough. Loading dose: 200 mg tid over 3 days. Maximum: 600 mg/d. IV therapy: 200 mg bid over 2 days, followed by 200 mg/d (maximum: 14 days).
^||In patients who cannot tolerate or who have infections refractory to standard therapy; loading dose: 70 mg on day 1 of therapy.
^¶Monitoring of serum levels required (< 100 µg/mL; target, 40 - 60 µg/mL). Dosage adjustment with reduced creatinine clearance.
^#Loading dose: twice the target dose on the first day of treatment. Dosage adjustment may be required with reduced creatinine clearance and high dosages.