Fungal Infection Management
Antifungal Therapies
- Topical antifungals are recommended as a preferred treatment option over oral terbinafine by the European Respiratory Society 1
- Nystatin is a suitable option for patients who are breastfeeding, as it is compatible with lactation 1
- Amphotericin B is recommended for the treatment of severe systemic infections by the Infectious Diseases Society of America, and is preferred over other options during pregnancy, especially in the first trimester, due to potential teratogenicity risks 2, 3, 4
- Fluconazole is considered compatible with breastfeeding by the American Academy of Pediatrics, with a concentration in breast milk approximately 85% of the plasma concentration, and is recommended by the Infectious Diseases Society of America and the European Respiratory Society/Thoracic Society of Australia and New Zealand as safe for use during breastfeeding, with an estimated daily infant dose of 0.39 mg/kg/day, representing 13% of the recommended pediatric dose for oropharyngeal candidiasis 1, 3, 5
- Itraconazole, posaconazole, and voriconazole are not recommended during breastfeeding due to insufficient data on their safety, according to the IDSA, ERS/TSANZ, and American Academy of Pediatrics 1, 3, 5
- No special monitoring of the infant is required when the mother is taking fluconazole, and interruption of breastfeeding is not necessary with fluconazole, as stated by the IDSA and American Academy of Pediatrics 3
- The American Academy of Pediatrics, IDSA, and ERS/TSANZ agree that fluconazole is the only azole antifungal that is likely safe for use during breastfeeding, and can be used without interruption of breastfeeding 1, 3, 5
Breastfeeding Considerations
The following antifungals are not recommended during breastfeeding due to insufficient data on their safety:
Antifungal Recommendation Itraconazole Not recommended Posaconazole Not recommended Voriconazole Not recommended Fluconazole is present in breast milk at levels less than the neonatal therapeutic dosage, with no adverse effects observed in breastfed infants whose mothers were taking fluconazole, as noted by the ERS/TSANZ task force statement 1