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
...Management...
...I. Candi...
...(caspofungin, loading dose 70 mg, t...
...conazole intravenous or oral, 800 mg (12 mg/...
...sting for azole susceptibility is r...
Transition from an echinocandin to flu...
...ion due to C. glabrata, transition to higher...
...rmulation amphotericin B (AmB) (3-5 mg/k...
...n from AmB to fluconazole is recommended a...
...atients with suspected azole and echinocandin-res...
...400 mg (6 mg/kg) twice daily for 2 doses, then...
...onazole is recommended as step-down oral th...
...non-neutropenic patients with candidemia...
...blood cultures should be performed...
...ed duration of therapy for candidemia without ob...
...hould be removed as early as possible in...
...III. Candid...
...echinocandin (caspofungin, loading dose 70...
...mulation AmB, 3-5 mg/kg daily, is an eff...
...0 mg (12 mg/kg) loading dose, then 400 mg (...
...onazole, 400 mg (6 mg/kg) daily, can be us...
...le, 400 mg (6 mg/kg) twice daily for 2...
...an also be used as step-down therapy during neut...
For infections due to C. krusei, an echinocandi...
...ed minimum duration of therapy for candidemia with...
...ical findings of choroidal and vitreal inf...
...n the neutropenic patient, sources of can...
...granulocyte transfusions can be considered in c...
...IV. Chr...
...with lipid formulation AmB, 3-5 mg/kg daily OR a...
...herapy should continue until lesions resolve on...
...motherapy or hematopoietic cell transpl...
...who have debilitating persistent f...
...V. Empirical Tr...
...irical antifungal therapy should be conside...
...mpirical antifungal therapy should be started...
...ical therapy for suspected candidiasis...
Fluconazole, 800 mg (12 mg/kg) load...
...ulation AmB, 3-5 mg/kg daily, is an...
...ended duration of empirical therapy for suspected...
...nts who have no clinical response to empirical...
...VI. Prophylaxi...
...800 mg (12 mg/kg) loading dose, then 400 m...
...tive is to give an echinocandin (caspofungin, 7...
...y bathing of ICU patients with chlorhexid...
...VII. Neona...
...Invasive C...
...ate, 1 mg/kg daily, is recommended for n...
...12 mg/kg IV or oral daily, is a reasonable alter...
...ormulation AmB, 3-5 mg/kg daily, is an alterna...
...hould be used with caution and generally...
...puncture and a dilated retinal examination are...
...ultrasound imaging of the genitou...
...venous catheter removal is strongly recomme...
...he recommended duration of therapy...
...initial treatment, AmB deoxycholate, 1 mg/kg...
...native regimen is liposomal AmB, 5 mg...
...n of flucytosine, 25 mg/kg 4 times daily, may be...
...down treatment after the patient has responde...
...uld continue until all signs, symp...
...ices, including ventriculostomy drains a...
...Prophylaxis i...
...eries with high rates (>10%) of inva...
...in, 100,000 units 3 times daily for 6 weeks,...
...ral bovine lactoferrin (100 mg/day) may...
...VIII. Intra-Abdominal...
...rical antifungal therapy should be cons...
...intra-abdominal candidiasis should...
...of antifungal therapy is the same as for...
...duration of therapy should be deter...
...IX. Candida Species in...
...Candida from respiratory secretions...
...X. Candida Intrava...
...Candida Endocarditis...
...endocarditis, lipid formulation AmB, 3...
...y to fluconazole, 400-800 mg (6-12 mg...
...e, 200-300 mg (3-4 mg/kg) twice daily, o...
...e replacement is recommended. Treatment sho...
...o cannot undergo valve replacement...
...thetic valve endocarditis, the same antifungal reg...
...uppressive antifungal therapy with fluco...
Candida...
...acemaker and implantable cardiac defibr...
...py is the same as that recommended for nati...
...ns limited to generator pockets, 4 we...
...tions involving the wires, ≥6 weeks of antifu...
...ricular assist devices that cannot b...
...ssive therapy with fluconazole if th...
...Candida Suppurative T...
...moval and incision and drainage or r...
...d formulation AmB, 3-5 mg/kg daily, OR fluconazo...
Step-down therapy to fluconazole, 400-80...
...on of the thrombus can be used as evidence to di...
...XI. C...
...Candida Osteomyelitis...
...zole 400 mg (6 mg/kg) daily, for 6-...
...mulation AmB, 3-5 mg/kg daily, for ≥2...
...cal debridement is recommended in sel...
...Candida Septic Art...
...zole, 400 mg (6 mg/kg) daily, for 6 weeks OR an...
...formulation AmB, 3-5 mg/kg daily, for 2 weeks...
...ical drainage is indicated in all cases of sep...
...arthritis involving a prosthetic device, device re...
...osthetic device cannot be removed, chronic s...
...XII. Candid...
...General Approach to Ca...
...nts with candidemia should have a di...
...r neutropenic patients it is recommended to delay...
...t of ocular infection (chorioretinit...
...ding antifungal treatment and surgical interven...
...Candi...
...fluconazole/voriconazole susceptible...
...le/voriconazole resistant isolates, liposomal...
...volvement, antifungal agents as noted ab...
...ration of treatment should be at lea...
...Candida Chorioretin...
...erapy as detailed above for chorioretiniti...
...tomy should be considered to decrease the burd...
...treatment should be ≥4-6 weeks, with the...
...XIII. Centr...
...tial treatment, liposomal AmB, 5 mg/kg daily, wi...
...therapy after the patient has responded to ini...
...hould continue until all signs and symp...
...S devices, including ventriculostomy dr...
...in whom a ventricular device cannot be removed,...
...XIV. Urinary T...
...Asymptomatic...
...n of predisposing factors, such as indwell...
...ent with antifungal agents is not rec...
...nic patients and very low birth weight infan...
...oing urologic procedures should be treated...
...Symptomatic Candida...
...onazole-susceptible organisms, oral fl...
...r fluconazole-resistant C. glabrata, Am...
...mB deoxycholate, 0.3-0.6 mg/kg daily, f...
...val of an indwelling bladder catheter, if...
...eoxycholate bladder irrigation, 50...
...Sym...
...nazole-susceptible organisms, oral fluconazole 2...
...e-resistant C. glabrata, AmB deoxycholate, 0.3-0.6...
...uconazole-resistant C. glabrata, monotherapy...
.... krusei, AmB deoxycholate, 0.3-0.6 m...
...rinary tract obstruction is strongly re...
...who have nephrostomy tubes or stents in...
...UTI Associated...
...vention is strongly recommended in adults. ( S/L )...
...ment as noted above for cystitis or py...
Irrigation through nephrostomy tubes, if pre...
...XV. Vulv...
...ent of uncomplicated Candida vulvo...
Alternatively, for the treatment of uncompl...
...e Candida vulvovaginitis, fluconazole,...
For C. glabrata vulvovaginitis that is...
...tive agent for C. glabrata infection...
...n for C. glabrata infection is topical...
...rring vulvovaginal candidiasis, 10-1...
...XVI. Oro...
..., clotrimazole troches, 10 mg 5 times dail...
...tives for mild disease include nystatin susp...
...moderate to severe disease, oral flucon...
...onazole-refractory disease, itraconazole...
...s for fluconazole-refractory disease i...
...nocandin (caspofungin, 70 mg loading...
...nic suppressive therapy is usually u...
...fected patients, antiretroviral therapy is stron...
...denture-related candidiasis, disi...
...XVII. Esophageal Cand...
...antifungal therapy is always required. A diagnost...
...azole, 200-400 mg (3-6 mg/kg) daily, for 14-21 da...
...cannot tolerate oral therapy: Intravenous...
...ed alternative for those who cannot tolerate o...
...de-escalating to oral therapy with flu...
...conazole-refractory disease, itracon...
...r fluconazole-refractory disease include an ech...
...conazole suspension, 400 mg twice daily, o...
...patients who have recurrent esophag...
...ed patients, antiretroviral therapy is strongly re...