Table 2.

Clinical practice guidelines for the treatment of blastomycosis⁵

Manifestation	Preferred Treatment	Comments
Table adapted from Chapman SW, Dismukes WE, Prioa LA, et al. Clinical Practice Guidelines for the Management of Blastomycosis: 2008 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(12):1801–1812.
Mild-to-moderate pulmonary and primary cutaneous	Itraconazole 200mg once or twice per day for 6–12 months	Reports of spontaneous resolution. No recommendation on the use of corticosteroids
Moderate-to-severe pulmonary	Lipid AmB 3–5mg/kg/day or deoxycholate AmB 0.7–1mg/kg/day for 1–2 weeks followed by itraconazole 200mg bid for 6–12 months	The entire course of therapy can be given with deoxycholate AmB to a total of 2g; however, most clinicians prefer to use stepdown itraconazole therapy after the patient’s condition improves. The lipid formulations of AmB have fewer adverse effects. Possible use of corticosteroids
Mild-to-moderate disseminated	Itraconazole 200mg once or twice per day for 6–12 months	Treat osteoarticular disease for 12 months
Moderate-to-severe disseminated	Lipid AmB 3–5mg/kg/day or deoxycholate AmB 0.7–1mg/kg/day for 1–2 weeks followed by itraconazole 200mg bid for 12 months	The entire course of therapy can be given with deoxycholate AmB to a total of 2g; however, most clinicians prefer to use stepdown itraconazole therapy after the patient’s condition improves. The lipid formulations of AmB have fewer adverse effects. Treat osteoarticular disease for 12 months. Possible use of corticosteroids
Immunosuppressed patients	Lipid AmB 3–5mg/kg/day or deoxycholate AmB 0.7–1mg/kg/day for 1–2 weeks followed by itraconazole 200mg bid for 12 months	Lifelong suppressive treatment may be required if immunosuppression cannot be reversed

AmB

amphotericin

bid

twice per day