Antiretroviral drugs fever

In a 39-year-old man efavirenz caused a confluent maculopapular rash, and pulmonary interstitial infiltrates without lymphadenopathy (21). The symptoms resolved when efavirenz was withdrawn while other antiretroviral drugs were continued. The patient was rechallenged, and the rash and fever reappeared however, recurrence of the pulmonary infiltrates was not addressed. 

Items 1-3 A hospitalized AIDS patient is receiving antiretroviral drugs but no antimicrobial prophylaxis. He develops sepsis with fever, suspected to be caused by a gram-negative bacillus. Treatment will include antibiotics, and the drugs under consideration include aminoglycosides, cephalosporins, fluoroquinolones, and imipenem. 

Itraconazole Topical 1% suspension 1 drop qlh Oral 200 mg PO qd-bid Topical not effective for severe infections, penetrates cornea poorly not commercially available must be compounded Penetrates all eye tissues poorly with oral administration Side effects include hepatotoxicity, gastrointestinal problems, hypokalemia, elevated Uver enzymes, rash, vasculitis, headache, fever, HTN, hypertriglyceridemia Many drug interactions exist including CYP3A4 substrates. Coadministration of itraconazole is contraindicated with multiple antiretrovirals (refer to Table 11-12) Pregnancy category C lactation safety unknown... 

Micafungin Topical 0.1% solution 1 drop ql h while awake Side effects include pulmonary edema, blood dyscrasias, hypercalcemia, hepatotoxicity (rare), gastrointestinal symptoms, headache, fever, chills, anemia, eosinophilia, hypokalemia, liver function test elevations, infusion site reactions. Drug interaction with cyclosporine and additional voriconazole. Pregnancy category C lactation safety unknown. Coadministration of caspofungin is contraindicated with multiple antiretrovirals (refer to Table 11-3) Topical not commercially available... 

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