Systemic mycoses

The principal treatment options are summarised in Table 14.2.

Pneumocystosis, caused by Pneumocystis carinii (now classified as a fungus), is an important cause of potentially fatal pneumonia in the immuno-suppressed. It is treated with co-trimoxazole in high dose (120 mg/kg daily in 2-4 divided doses for 14 days by mouth or i.v. infusion). Intolerant or resistant cases may benefit from pentamidine or, if mild to moderate, from atovaquone, or trimetrexate (given with calcium folinate). Co-trimoxazole by mouth or intermittent inhaled pentamidine are used for prophylaxis in patients with AIDS.

• Drugs that disrupt the fungal cell membrane polyenes,: e.g. amphotericin

□zoles: imidazoles, e.g. ketoconazole triazoles.e.g.

fluconazole

¿llylomine: terbinafine

• Drug that inhibits mitosis: griseofulvin

• Drug that inhibits DNA synthesis: flucytosine

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