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
...I...
...andin (caspofungin, loading dose 70 mg...
...intravenous or oral, 800 mg (12 mg/kg)...
...zole susceptibility is recommended for...
...tion from an echinocandin to fluconazole...
...infection due to C. glabrata, transiti...
...d formulation amphotericin B (AmB) (3...
...nsition from AmB to fluconazole is recom...
...atients with suspected azole and echinocandi...
...riconazole 400 mg (6 mg/kg) twice daily for...
...ole is recommended as step-down oral thera...
...on-neutropenic patients with candidemia sho...
...blood cultures should be performed e...
...mended duration of therapy for candidemia with...
...VCs should be removed as early as possible in th...
...III. Candidemia in Neu...
...(caspofungin, loading dose 70 mg, then 50 mg da...
...formulation AmB, 3-5 mg/kg daily, is...
...800 mg (12 mg/kg) loading dose, then 400 mg (6 m...
...nazole, 400 mg (6 mg/kg) daily, can...
...00 mg (6 mg/kg) twice daily for 2 doses,...
...ole can also be used as step-down therap...
...ue to C. krusei, an echinocandin,...
...mmended minimum duration of therapy for candidem...
...ogical findings of choroidal and vitreal in...
...ic patient, sources of candidiasis other...
...ilized granulocyte transfusions can be...
...IV. Chronic Diss...
...apy with lipid formulation AmB, 3-5 mg/kg daily...
...ontinue until lesions resolve on repeat ima...
...erapy or hematopoietic cell transplantation is req...
...tients who have debilitating persistent fever...
...V. Empirical...
Empirical antifungal therapy should be...
...antifungal therapy should be started a...
...empirical therapy for suspected candidia...
...800 mg (12 mg/kg) loading dose, then 400 mg...
...on AmB, 3-5 mg/kg daily, is an alternative if the...
...ommended duration of empirical thera...
...who have no clinical response to empirical an...
...VI. Prophyla...
...00 mg (12 mg/kg) loading dose, then 400 mg (...
...s to give an echinocandin (caspofung...
...of ICU patients with chlorhexidine, which has...
...VII. Ne...
...Invasive Candidia...
...ate, 1 mg/kg daily, is recommended for neonates w...
...mg/kg IV or oral daily, is a reasonab...
...lation AmB, 3-5 mg/kg daily, is an alternative, b...
...ins should be used with caution and genera...
...mbar puncture and a dilated retinal examination...
...ound imaging of the genitourinary tract, l...
...l venous catheter removal is strongly recommen...
...nded duration of therapy for candid...
...CNS infections in Ne...
For initial treatment, AmB deoxychola...
...regimen is liposomal AmB, 5 mg/kg daily...
...he addition of flucytosine, 25 mg/kg 4 times d...
...treatment after the patient has re...
...y should continue until all signs, symptoms, and C...
...ices, including ventriculostomy drain...
...ries with high rates (>10%) of invasive can...
...nystatin, 100,000 units 3 times daily for 6...
...toferrin (100 mg/day) may be effect...
...VI...
...al antifungal therapy should be consi...
...t of intra-abdominal candidiasis sho...
...e choice of antifungal therapy is the same as for...
...ration of therapy should be determined by adequa...
...IX. Candida Species i...
Growth of Candida from respiratory secretions us...
...X. Candida Intr...
...Candida Endocarditis...
...native valve endocarditis, lipid formu...
...apy to fluconazole, 400-800 mg (6-12 mg/kg)...
...ral voriconazole, 200-300 mg (3-4 mg/kg) twice...
...e replacement is recommended. Treatme...
...or patients who cannot undergo valv...
...prosthetic valve endocarditis, the same antifung...
...nic suppressive antifungal therapy with fluc...
...Candida Infec...
...er and implantable cardiac defibri...
...erapy is the same as that recommend...
...or infections limited to generator pockets, 4 we...
...ns involving the wires, ≥6 weeks of ant...
...or ventricular assist devices that cannot be...
...essive therapy with fluconazole if the is...
...Candida Supp...
...oval and incision and drainage or r...
...formulation AmB, 3-5 mg/kg daily,...
...down therapy to fluconazole, 400-800 mg (6-...
...on of the thrombus can be used as evidence to d...
...XI. Candida O...
...Candida Osteomyelit...
...le 400 mg (6 mg/kg) daily, for 6-12 months...
Lipid formulation AmB, 3-5 mg/kg daily, for...
...debridement is recommended in selected cases...
...Candida Septic A...
Fluconazole, 400 mg (6 mg/kg) daily,...
...ipid formulation AmB, 3-5 mg/kg daily, for 2...
...nage is indicated in all cases of septi...
...septic arthritis involving a prosthetic device,...
...thetic device cannot be removed, chroni...
...XII. Candida E...
Gener...
...with candidemia should have a dilated r...
...or neutropenic patients it is recommended to d...
The extent of ocular infection (chorioretinitis...
...ions regarding antifungal treatment and surgi...
...Candida Chorioretinit...
For fluconazole/voriconazole susceptible isol...
...zole/voriconazole resistant isolate...
...acular involvement, antifungal agents as...
...treatment should be at least 4-6 weeks, with the...
...Candida Chorioretin...
...therapy as detailed above for chorioretinitis wi...
...ld be considered to decrease the burden of o...
...f treatment should be ≥4-6 weeks,...
...XIII. Central...
...itial treatment, liposomal AmB, 5 mg/...
...r step-down therapy after the patient has respond...
...continue until all signs and symptoms,...
...cted CNS devices, including ventric...
...atients in whom a ventricular device cannot be...
XI...
...Asym...
...ion of predisposing factors, such as indwelling...
...th antifungal agents is not recommen...
...atients and very low birth weight infants sh...
...atients undergoing urologic procedures s...
...Symptomatic Cand...
...r fluconazole-susceptible organisms,...
...fluconazole-resistant C. glabrata, AmB deoxy...
...rusei, AmB deoxycholate, 0.3-0.6 mg/kg...
...an indwelling bladder catheter, if feasible, i...
...holate bladder irrigation, 50 mg/L sterile wat...
...Symptom...
...uconazole-susceptible organisms, oral fluconazol...
...conazole-resistant C. glabrata, Am...
For fluconazole-resistant C. glabrata,...
...C. krusei, AmB deoxycholate, 0.3-0.6 mg/kg d...
...imination of urinary tract obstruction is stron...
...patients who have nephrostomy tubes or stents...
...UTI Associate...
...l intervention is strongly recommended in...
...treatment as noted above for cystiti...
...ion through nephrostomy tubes, if pre...
...XV. Vulvov...
...the treatment of uncomplicated Candi...
...ely, for the treatment of uncomplicate...
...ere acute Candida vulvovaginitis, flucona...
...rata vulvovaginitis that is unresponsi...
...other alternative agent for C. glabrat...
...or C. glabrata infection is topical 17% flucytos...
...ecurring vulvovaginal candidiasis, 10-14 day...
...XVI. Oropharyng...
...mild disease, clotrimazole troches, 10 mg 5 times...
...es for mild disease include nystatin suspension...
For moderate to severe disease, oral fluconazole,...
...or fluconazole-refractory disease, itraconazole...
...tives for fluconazole-refractory disease...
...echinocandin (caspofungin, 70 mg loading dose,...
...essive therapy is usually unnecessa...
...d patients, antiretroviral therapy is...
...nture-related candidiasis, disinfection of...
...XVII. E...
...ntifungal therapy is always required. A di...
...azole, 200-400 mg (3-6 mg/kg) daily...
...who cannot tolerate oral therapy: Intr...
...s preferred alternative for those who cann...
...alating to oral therapy with fluconazol...
...refractory disease, itraconazole solution, 200 mg...
...rnatives for fluconazole-refractory disease incl...
...pension, 400 mg twice daily, or extended-r...
For patients who have recurrent esop...
...HIV-infected patients, antiretroviral t...