Candida
Key Points
Key Points
There are at least 15 distinct Candida species that cause human disease, but over 90% of invasive disease is caused by the 5 most common pathogens, C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei.
Each of these organisms has unique virulence potential, antifungal susceptibility, and epidemiology.
Taken as a whole, significant infections due to these organisms are generally referred to as “invasive candidiasis,” except for mucosal Candida infections, especially those involving the oropharynx, esophagus and vagina, which are not considered to be classically invasive disease.
Note: All recommended antimicrobial drug doses are for adults. Please consult drug PIs for pediatric doses.
Management
...nagement
...Candidemia in Non-Neutropenic Patients...
...in (caspofungin, loading dose 70 mg, then 50 mg...
Fluconazole intravenous or oral, 800 mg (12 mg/...
...r azole susceptibility is recommended for all blo...
...ition from an echinocandin to fluconazole...
...e to C. glabrata, transition to hi...
...ion amphotericin B (AmB) (3-5 mg/kg dai...
...ansition from AmB to fluconazole is re...
...patients with suspected azole and echino...
...mg (6 mg/kg) twice daily for 2 doses, th...
...le is recommended as step-down oral therapy...
...ll non-neutropenic patients with candidem...
...ow-up blood cultures should be performed ever...
Recommended duration of therapy for...
...al Venous Catheters (CVCs) in Non-Neu...
...be removed as early as possible in the...
.... Candidemia in Neutropenic...
...ocandin (caspofungin, loading dose 70 mg, then...
...id formulation AmB, 3-5 mg/kg daily, is an...
..., 800 mg (12 mg/kg) loading dose, then 400 mg (6...
...e, 400 mg (6 mg/kg) daily, can be used for step-...
Voriconazole, 400 mg (6 mg/kg) twice daily...
...also be used as step-down therapy during ne...
...fections due to C. krusei, an echi...
...minimum duration of therapy for candidemia witho...
...findings of choroidal and vitreal...
...utropenic patient, sources of candidiasis ot...
...granulocyte transfusions can be consider...
...ic Disseminated (Hepatosplenic) Candidias...
...ial therapy with lipid formulation A...
...d continue until lesions resolve on re...
...or hematopoietic cell transplantation is...
...have debilitating persistent fevers, sh...
...Empirical Treatment for Suspected Invasi...
...antifungal therapy should be consider...
...antifungal therapy should be started as...
...ical therapy for suspected candidiasis in non-n...
...azole, 800 mg (12 mg/kg) loading dose,...
...rmulation AmB, 3-5 mg/kg daily, is...
...ed duration of empirical therapy for suspected inv...
...ients who have no clinical response to empirical a...
...ylaxis to Prevent Invasive Candidiasis in the ICU...
...800 mg (12 mg/kg) loading dose, the...
...n alternative is to give an echinocandin (caspo...
...g of ICU patients with chlorhexidine, which ha...
...I. Neonatal Candidiasis, including Central Nerv...
...ve Candidiasis and Candidemi...
...te, 1 mg/kg daily, is recommended for neonates...
...nazole, 12 mg/kg IV or oral daily, is a...
...tion AmB, 3-5 mg/kg daily, is an alternati...
...ocandins should be used with caution and gen...
...puncture and a dilated retinal examinat...
...imaging of the genitourinary tract, liver...
...l venous catheter removal is strongly recommen...
...e recommended duration of therapy f...
...infections in Neonate...
...initial treatment, AmB deoxycholate, 1 mg/kg IV...
...ernative regimen is liposomal AmB, 5 mg...
...f flucytosine, 25 mg/kg 4 times daily, may be...
...or step-down treatment after the patient has res...
...y should continue until all signs,...
...S devices, including ventriculostomy drai...
...n the Neonatal ICU Setting...
...n nurseries with high rates (>10%) of inv...
...atin, 100,000 units 3 times daily for...
...ctoferrin (100 mg/day) may be effec...
...III. Intra-Abdominal Candidiasis...
...ntifungal therapy should be considered for pati...
...intra-abdominal candidiasis should include s...
...ice of antifungal therapy is the same a...
...on of therapy should be determined by adequacy o...
...dida Species in the Respiratory Tract...
...da from respiratory secretions usually indicates c...
...a Intravascular Infections, Including Endocard...
...a Endocarditis...
For native valve endocarditis, lipid fo...
...erapy to fluconazole, 400-800 mg (6-12 mg/...
...nazole, 200-300 mg (3-4 mg/kg) twice daily, or po...
...alve replacement is recommended. Treatm...
...patients who cannot undergo valve re...
...rosthetic valve endocarditis, the same antifun...
...suppressive antifungal therapy with fluconazole,...
...on of Implantable Cardiac Devices...
...cemaker and implantable cardiac defibril...
...herapy is the same as that recommended...
...limited to generator pockets, 4 weeks of anti...
...fections involving the wires, ≥6 w...
...ar assist devices that cannot be remov...
...pressive therapy with fluconazole if t...
...Suppurative Thrombophlebitis...
...and incision and drainage or resection of t...
...pid formulation AmB, 3-5 mg/kg dail...
...tep-down therapy to fluconazole, 400...
...on of the thrombus can be used as evidence to...
...Osteoarticular Infections...
...Osteomyelitis...
...0 mg (6 mg/kg) daily, for 6-12 months OR an...
...formulation AmB, 3-5 mg/kg daily, for ≥2...
...ebridement is recommended in selected cases. (...
...a Septic Arthritis...
...00 mg (6 mg/kg) daily, for 6 weeks O...
...ipid formulation AmB, 3-5 mg/kg daily, for 2 weeks...
...gical drainage is indicated in all cases of septi...
...septic arthritis involving a prosthetic dev...
...osthetic device cannot be removed, c...
...andida Endophthalmiti...
...oach to Candida Endophthalmitis...
...with candidemia should have a dilated retinal ex...
...openic patients it is recommended to delay...
...xtent of ocular infection (chorioretin...
...s regarding antifungal treatment and surgi...
Candida Chorioretinitis WITHOUT Vit...
...nazole/voriconazole susceptible isolate...
...uconazole/voriconazole resistant iso...
...volvement, antifungal agents as noted...
...of treatment should be at least 4-6 weeks, with t...
...rioretinitis WITH Vitritis...
Antifungal therapy as detailed above for chorioret...
...hould be considered to decrease the burden o...
...duration of treatment should be ...
...tral Nervous System (CNS) Candidiasis...
...tial treatment, liposomal AmB, 5 mg/kg daily, wi...
For step-down therapy after the patient has respon...
...uld continue until all signs and sym...
...CNS devices, including ventriculostomy dr...
...r patients in whom a ventricular dev...
...Urinary Tract Infections Due to Candida Spe...
...tomatic Candiduria
...ation of predisposing factors, suc...
...antifungal agents is not recommended unl...
...tients and very low birth weight infants sho...
...oing urologic procedures should be...
...ic Candida Cystitis...
...conazole-susceptible organisms, oral fluconazole,...
...e-resistant C. glabrata, AmB deoxycholat...
...ei, AmB deoxycholate, 0.3-0.6 mg/kg daily, for 1-...
...ndwelling bladder catheter, if feasible, is stro...
...late bladder irrigation, 50 mg/L sterile wat...
...ic Ascending Candida Pyelonephriti...
...fluconazole-susceptible organisms, oral f...
...fluconazole-resistant C. glabrata, AmB deoxycholat...
...onazole-resistant C. glabrata, monotherapy...
...i, AmB deoxycholate, 0.3-0.6 mg/kg daily, for 1...
Elimination of urinary tract obstruc...
...ents who have nephrostomy tubes or stents in place...
UTI Associated with Fung...
...rgical intervention is strongly recommended in...
...reatment as noted above for cystitis...
...ugh nephrostomy tubes, if present, with AmB deox...
...ovaginal Candidiasis...
...ent of uncomplicated Candida vulvovagini...
...vely, for the treatment of uncomplica...
...e Candida vulvovaginitis, fluconazole, 150 mg,...
...or C. glabrata vulvovaginitis that is...
...lternative agent for C. glabrata infection is n...
...option for C. glabrata infection is topical 1...
...ing vulvovaginal candidiasis, 10-14 days o...
...I. Oropharyngeal Candidiasis...
...disease, clotrimazole troches, 10 m...
...ves for mild disease include nystat...
...oderate to severe disease, oral fluconazo...
...fluconazole-refractory disease, itraconaz...
...natives for fluconazole-refractory disease include...
...echinocandin (caspofungin, 70 mg loading...
...essive therapy is usually unnecessary....
...patients, antiretroviral therapy is st...
For denture-related candidiasis, disinfec...
...sophageal Candidias...
...antifungal therapy is always required. A diagnost...
...uconazole, 200-400 mg (3-6 mg/kg) daily, for 14-...
...ho cannot tolerate oral therapy: I...
...less preferred alternative for those...
...calating to oral therapy with fluconazole 200-40...
...conazole-refractory disease, itraconazole so...
...for fluconazole-refractory disease...
...azole suspension, 400 mg twice daily, or...
...nts who have recurrent esophagitis,...
...nfected patients, antiretroviral therapy i...