526 DISEASES/DISORDERS
AMB administered by rapid IV bolus at a dosage of 0.25 mg/kg, three times a
week, for a total cumulative dosage of 4 mg/kg followed by long-term ketocona-
zole therapy, depending on the clinical response.Flucytosine 100 mg/kg PO divided TID to QID in addition to triazoles may be con-
sidered for resistant infections: associated with drug eruptions manifesting as depig-
menting lesions of the skin, lips, and nose, as well as bone marrow suppression.Precautions/Interactions
Avoid use of antacids with imidazole and triazole medications.
Drugs metabolized primarily by the liver should not be administered along with
ketoconazole.
Drugs metabolized primarily by the kidneys should not be administered along with
AMB.
Pulmonary disease resulting in severe coughing may temporarily worsen after therapy
has begun due to inflammation in the lungs; low-dose short-term prednisone and
cough suppressants may be required to alleviate the respiratory signs.COMMENTS
Patient Monitoring
Serologic titers (cryptococcosis, coccidioidomycosis) should be monitored every 1–
3 months after initial 2-month treatment.
Treatment is continued 60 days after antigen titers reach zero (cryptococcosis – may
take>2 years) or less than 1:4 (coccidioidomycosis).
Serum drug levels 2–4 h post administration may be considered in patients displaying
poor response to assure adequate absorption.
Blastomycosis: monitor thoracic radiographs at 90 days; continue treatment with
repeat radiographs at 30-day intervals until lungs are normal or stable (indicating
residual scarring).Expected Course and Prognosis
Cryptococcosis:
Chronic disease: requires months of therapy; patients with CNS disease may
require life-long maintenance therapy
Not considered a zoonotic disease but may be transmitted via bite wounds, espe-cially to an immunocompromised human
Capsular antigen titers determine response to therapy; if titers do not substan-tially decrease with 2 months of treatment, protocol may need to be changed
Poorer prognosis in cats with concurrent FeLV or FIV infection. Coccidioidomycosis:
Prognosis is guarded in disseminated disease