TABLE 3.

Recommendations for treatment of blastomycosisa

Disease manifestation/patient typePreferred treatmentComments
Mild to moderate pulmonary or disseminated disease200 mg itraconazole orally once or twice per dayb for 6-12 moTreat osteoarticular disease for 12 mo
Moderately severe to severe pulmonary or disseminated disease, but not in the central nervous system0.7-1.0 mg amphotericin B deoxycholate/kg per day, or 3-5 mg lipid amphotericin B/kg per day for 1-2 wk, followed by 200 mg itraconazole twice per dayb for 6-12 mo (pulmonary) or 12 mo (disseminated)Amphotericin B deoxycholate given at a total dose of 2 g can be used for the entire course of treatment, but most clinicians prefer to step-down to itraconazole after initial improvement; lipid amphotericin B products have fewer adverse effects than deoxycholate
Central nervous system disease5 mg lipid amphotericin B/kg per day for 4-6 wk, followed by an oral azole for at least 1 yrAzole options for step-down therapy include 200 mg itraconazole twice or thrice per day, 800 mg fluconazole per day, and 200-400 mg voriconazole twice per day
Immunosuppressed patients0.7-1.0 mg amphotericin B deoxycholate/kg per day, or 3-5 mg lipid amphotericin B/kg per day for 1-2 wk, followed by 200 mg itraconazole twice per dayb for 12 moLifelong suppressive therapy may be necessary for patients whose immunocompetence does not improve
Pregnant patients3-5 mg lipid amphotericin B/kg per daySystemic azole therapy is contraindicated in pregnancy
  • a Adapted from reference 27 with permission of The University of Chicago Press.

  • b The dose of itraconazole for pediatric patients is 10 mg/kg per day, not to exceed 400 mg per day.