What are antifungals that can be used in intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Answer

Antifungals that can be used for switch therapy include itraconazole and fluconazole.

Itraconazole and fluconazole

The efficacy and safety of intravenous and oral itraconazole and intravenous and oral fluconazole for long-term prophylaxis of fungal infections in transplantation patients have been established; itraconazole is better tolerated. Generally, in patients who can take oral medications, itraconazole and fluconazole can be given orally with no adverse effects or effect on outcomes. Similarly, in 2002, Purkins et al noted that switching from intravenous to oral voriconazole can be effectively achieved. [42]

Specifically, in 2002, Winston and Busuttil reported a study in which adult liver transplant recipients were randomized to receive either an oral itraconazole solution (200 mg q12h) or intravenous/oral fluconazole (400 mg/d). Each study drug was started immediately before the transplantation surgery and continued for 10 weeks after transplantation. Patients were evaluated for fungal colonization, proven invasive or superficial fungal infection, drug-related adverse effects, and death. Results were similar. [43]

In patients with candidemia, successful protocols in a study of 37 patients have been developed to step down intravenous echinocandin or voriconazole to oral fluconazole, with only one failure. [44]


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