Invasive Fungal sinusitis

- In immunocompromised patients/diabetic ketoacidosis, a fungal infection can present as a cellulitis that may rapidly progress and be fatal. Surgical debridement is necessary.

- Infectious Diseases consult recommended.

Usual Pathogens

Aspergillus spp
Rhizopus spp
Mucor spp

Immunocompromised / diabetic ketoacidosis

Aspergillus – see Invasive Aspergillosis

Rhizopus/Mucor

Empiric Therapy	Dose	Duration
Amphotericin B, liposomal	5-10mg/kg IV daily	Until clinical and radiographic resolution and reversal of immunosuppression, if possible. Suppressive therapy then usually continued for at least 3-6 months, or life-long if continuing immunosuppression.

Alternative/Oral switch therapy

Empiric Therapy	Dose	Duration
Posaconazole	300mg DR tab PO bid on day 1, then 300mg DR tab PO daily	Until clinical and radiographic resolution and reversal of immunosuppression, if possible. Suppressive therapy then usually continued for at least 3-6 months, or life-long if continuing immunosuppression.
or
Isavuconazole	200mg PO q8h x 6 doses then 12-24h later 200mg PO daily	Until clinical and radiographic resolution and reversal of immunosuppression, if possible. Suppressive therapy then usually continued for at least 3-6 months, or life-long if continuing immunosuppression.

Empiric Therapy

Duration

Posaconazole

300mg DR tab PO bid on day 1, then

300mg DR tab PO daily

Until clinical and radiographic resolution and reversal of immunosuppression, if possible. Suppressive therapy then usually continued for at least 3-6 months, or life-long if continuing immunosuppression.

or

Isavuconazole

200mg PO q8h x 6 doses then

12-24h later 200mg PO daily

Until clinical and radiographic resolution and reversal of immunosuppression, if possible. Suppressive therapy then usually continued for at least 3-6 months, or life-long if continuing immunosuppression.