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Trichosporon Infections (Treatment)

eMedicine.com, 2011

Treatment Medical Care High-dose amphotericin B deoxycholate (1-1.5 mg/kg/d) has been the historic cornerstone for treatment of invasive disease due to Trichosporon .
Because of high rates of resistance to amphotericin B and the toxicity of this regimen, alternate therapies are often necessary.
Lipid preparations of amphotericin B (eg, liposomal amphotericin B 5 mg/kg/d) are commonly used in place of amphotericin B deoxycholate.
The addition of high-dose fluconazole (800-1600 mg/d) and 5-flucytosine to amphotericin B has improved clinical response rates.
The echinocandins (caspofungin, micafungin, anidulafungin) act by inhibiting the beta-glucan cell wall of Trichosporon .
One report has described successful treatment of T inkin peritoneal catheter–associated peritonitis using caspofungin monotherapy.
More recently, however, cases of breakthrough T asahii infections have been reported in patients with hematologic malignancies receiving micafungin for empiric treatment of neutropenic fever.
One in vivo murine model of trichosporonosis showed a significant reduction in fungal burden in multiple infected organ systems when amphotericin B was combined with micafungin.
The newer triazoles (eg, voriconazole, posaconazole, ravuconazole) show excellent in vitro activity against Trichosporon .
Posaconazole (Noxafil) was recently approved by the US Food and Drug Administration for prophylaxis of invasive Aspergillus and Candida infections in patients at high risk because of severe immunosuppression.
Successful clearance of fungemia with voriconazole has been reported in one patient in whom liposomal amphotericin B treatment was failing.