Naegleria fowleri: Difference between revisions

Revision as of 02:31, 4 June 2020

Causes acute, aggressive primary amebic meningoencephalitis (PAM)
Infection (PAM) is rapidly-progressing and almost uniformly fatal (141/145 cases in the US)

Unclear optimal management
CDC recommendations are:
- Amphotericin B 0.75 mg/kg IV q12h for three days followed by 1 mg/kg IV daily for 11 days, followed by
- Amphotericin B 1.5 mg intrathecal once daily for 2 days followed by 1 mg intrathecal q2d for 8 days, followed by
- Azithromycin 10 mg/kg (max 500 mg) PO/IV daily, plus fluconazole 10 mg/kg (max 600 mg) PO/IV daily, plus rifampin 10 mg/kg (max 600 mg) PO/IV daily, plus miltefosine 50 mg PO bid or tid for 28 days, with dexamethasone 0.15 mg/kg IV q6h during the initial 4 days

Note that the recommendation is specifically for conventional rather than liposomal amphotericin B
Miltefosine dosing is bid if weight <45 kg and tid if weight ≥45 kg

@@ Line 14: / Line 14: @@
 * CDC recommendations are:
 ** [[Is treated by::Amphotericin B]] 0.75 mg/kg IV q12h for three days followed by 1 mg/kg IV daily for 11 days, followed by
+** [[Is treated by::Amphotericin B]] 1.5 mg intrathecal once daily for 2 days followed by 1 mg intrathecal q2d for 8 days, followed by
 ** [[Is treated by::Azithromycin]] 10 mg/kg (max 500 mg) PO/IV daily, plus [[Is treated by::fluconazole]] 10 mg/kg (max 600 mg) PO/IV daily, plus [[Is treated by::rifampin]] 10 mg/kg (max 600 mg) PO/IV daily, plus [[Is treated by::miltefosine]] 50 mg PO bid or tid for 28 days, with [[Is treated by::dexamethasone]] 0.15 mg/kg IV q6h during the initial 4 days
 {{DISPLAYTITLE:''Naegleria fowleri''}}