June 30, 2008

Updated Blastomycosis Guidelines Feature New Treatments

New guidelines on the management of blastomycosis include several new therapies developed since the 2000 edition was published.

The guidelines were updated in response to the availability of these new treatments, as well as the increased occurrence of blastomycosis in immunosuppressed patients and others.  Recent reports have indicated an increase in blastomycosis cases in Midwestern, Southeastern, and South-central areas of the United States.  Many, but not all, of these cases have been associated with occupational exposure or recreational activities, primarily around streams or rivers.

Since the 2000 publication, new antifungal therapies have been used for the treatment of blastomycosis.  The guidelines recommend that all infected individuals should be treated with antifungal therapy.  Amphotericin B, either a lipid formulation or deoxycholate formulation, is recommended for severe pulmonary or disseminated infection and for all immunosuppressed patients as initial therapy.  Oral itraconazole is recommended as initial therapy for patients with mild to moderate pulmonary or disseminated blastomycosis and for step-down therapy in patients who have severe blastomycosis. 

The guidelines provide new or updated recommendations for pulmonary, disseminated extrapulmonary, and central nervous system blastomycosis. They also cover treatment for immunosuppressed patients, pregnant women, and children.

Specific performance measures have been added. These emphasize the appropriate treatment for various forms of blastomycosis and the expected monitoring of serum itraconazole concentrations and adverse reactions associated with amphotericin B formulations.

The guidelines are available online and in the June 15 issue of Clinical Infectious Diseases (CID 2008;46:1801–1812).

Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.

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