Induction Therapy

Preferred Therapy:

• Liposomal amphotericin B at 3 mg/kg IV daily (AI)

Alternative Therapy:

• Amphotericin B lipid complex 5 mg/kg IV daily (AIII)

Duration:

• For at least 2 weeks or until clinically improved

Maintenance Therapy

Preferred Therapy:

• Itraconazole 200 mg PO three times daily for 3 days, then twice daily for at least 12 months (AII), with dosage adjustment based on interactions with antiretroviral medications and results from itraconazole serum concentration 

Induction and Maintenance Therapy

Preferred Therapy:

• Itraconazole 200 mg PO three times daily for 3 days, then 200 mg PO twice daily for ≥12 months (AII), with dosage adjustment based on interactions with antiretroviral medications and results from itraconazole serum concentration

Alternative Therapy:

Note: These recommendations are based on limited clinical data for patients intolerant to itraconazole and who are only moderately ill.

• Posaconazole, extended release tablet, 300 mg PO twice daily for 1 day, then 300 mg PO once daily (BIII)
• Voriconazole 400 mg PO twice daily for 1 day, then 200 mg PO twice daily (BIII)
• Fluconazole 800 mg PO once daily (CII)

Induction Therapy (4-6 weeks)

• Liposomal amphotericin B 5 mg/kg IV daily (AIII)

Maintenance Therapy

• Itraconazole 200 mg PO twice or three times daily for at least 12 months and until resolution of abnormal cerebrospinal findings with dosage adjustment based on interactions with antiretroviral medications and results from itraconazole serum concentration (AIII)

Alternative Maintenance Therapy

Note: These recommendations are based on limited clinical data for patients intolerant to itraconazole.

• Voriconazole 400 mg PO twice daily for 1 day, then 200 mg PO twice daily (BIII)
• Posaconazole, extended release tablet, 300 mg PO twice daily for 1 day, then 300 mg PO once daily(BIII)
• Fluconazole 800 mg PO once daily (CII)