Treatment of Severe Pulmonary Blastomycosis in a Child Under 18

This protocol applies to a pediatric patient (age under 18) presenting with severe pulmonary blastomycosis — a high-acuity presentation that requires an age-specific treatment approach.

Clinical Situation

Severe disease in a child under 18 is the defining feature of this pathway. Both the patient's age and disease severity together determine the appropriate treatment selection and sequencing.

Management begins with intravenous amphotericin B, followed by step-down to oral itraconazole for an extended treatment course. Formulation choice, the criteria for transition, and total duration are specified in the full protocol.

The complete regimen — all options, step-down sequencing, and duration — is available below.

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References

DOI: 10.1086/588300

For children with severe blastomycosis, AmB deoxycholate, 0.7–1.0 mg/kg per day, or lipid formulation AmB, at a dosage of 3–5 mg/kg per day, is recommended for initial therapy, followed by oral itraconazole, 10 mg/kg per day (up to 400 mg per day) as step-down therapy, for a total of 12 months (B-III).

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