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
...agement...
...Candidemia in Non-Neutropenic Patients...
...(caspofungin, loading dose 70 mg, then 5...
...ole intravenous or oral, 800 mg (12 mg/kg) l...
...e susceptibility is recommended for all blo...
...om an echinocandin to fluconazole (usually...
...due to C. glabrata, transition to hi...
Lipid formulation amphotericin B (AmB) (3...
Transition from AmB to fluconazole is recommended...
Among patients with suspected azole and echinocan...
...onazole 400 mg (6 mg/kg) twice daily...
...is recommended as step-down oral therapy f...
...penic patients with candidemia should ha...
...p blood cultures should be performed every day...
...mmended duration of therapy for candidem...
...entral Venous Catheters (CVCs) in Non-Neutrope...
...e removed as early as possible in th...
...II. Candidemia in Neutropenic Patient...
...echinocandin (caspofungin, loading dose 70...
...ation AmB, 3-5 mg/kg daily, is an...
..., 800 mg (12 mg/kg) loading dose, then 400...
..., 400 mg (6 mg/kg) daily, can be used f...
...onazole, 400 mg (6 mg/kg) twice daily...
...iconazole can also be used as step-down therapy du...
...ue to C. krusei, an echinocandin, lipid form...
Recommended minimum duration of ther...
...gical findings of choroidal and vi...
...ropenic patient, sources of candidia...
...ilized granulocyte transfusions can be...
IV. Chronic Disseminated (Hepatosplenic...
...erapy with lipid formulation AmB, 3-5 mg/kg da...
...continue until lesions resolve on re...
...therapy or hematopoietic cell transplantat...
...who have debilitating persistent fevers, short...
...cal Treatment for Suspected Invasive Can...
...pirical antifungal therapy should be c...
...irical antifungal therapy should be...
...ical therapy for suspected candidiasis in no...
...00 mg (12 mg/kg) loading dose, then 400 mg (6 mg/...
...lation AmB, 3-5 mg/kg daily, is an alternat...
...duration of empirical therapy for suspected in...
For patients who have no clinical response to emp...
...s to Prevent Invasive Candidiasis...
Fluconazole, 800 mg (12 mg/kg) loadin...
...is to give an echinocandin (caspofun...
...athing of ICU patients with chlorhe...
...II. Neonatal Candidiasis, including Central...
...andidiasis and Candidemia...
...late, 1 mg/kg daily, is recommended for ne...
Fluconazole, 12 mg/kg IV or oral dai...
...ation AmB, 3-5 mg/kg daily, is an alt...
...s should be used with caution and g...
A lumbar puncture and a dilated retinal...
...nd imaging of the genitourinary tract, liver, and...
...nous catheter removal is strongly re...
...ended duration of therapy for cand...
...infections in Neona...
...eatment, AmB deoxycholate, 1 mg/kg...
...native regimen is liposomal AmB, 5 mg/kg dail...
...of flucytosine, 25 mg/kg 4 times daily, may be c...
...ep-down treatment after the patient has re...
...y should continue until all signs, sympt...
...fected CNS devices, including ventriculostomy dr...
...laxis in the Neonatal ICU Setting...
...s with high rates (>10%) of invasive...
...atin, 100,000 units 3 times daily for 6 weeks...
...lactoferrin (100 mg/day) may be effective...
.... Intra-Abdominal Candidiasis
...cal antifungal therapy should be con...
...tment of intra-abdominal candidiasis sh...
...e of antifungal therapy is the same as for the tr...
...of therapy should be determined by...
...Species in the Respiratory Tract...
...f Candida from respiratory secretions usually...
...a Intravascular Infections, Includin...
...ida Endocarditis...
...ive valve endocarditis, lipid formulation AmB...
Step-down therapy to fluconazole, 400-800 mg...
...voriconazole, 200-300 mg (3-4 mg/kg) twice daily...
Valve replacement is recommended. Treatment s...
...nts who cannot undergo valve replacement, lo...
...sthetic valve endocarditis, the same ant...
...ive antifungal therapy with fluconazole...
...a Infection of Implantable Cardiac Devices...
...and implantable cardiac defibrillator infect...
...gal therapy is the same as that recommend...
...nfections limited to generator pockets, 4 wee...
...ions involving the wires, ≥6 week...
...ventricular assist devices that cannot be remo...
...ive therapy with fluconazole if th...
...Suppurative Thrombophlebitis...
...eter removal and incision and drainage or res...
...ipid formulation AmB, 3-5 mg/kg daily, OR flucon...
...ep-down therapy to fluconazole, 400-800 mg (6...
...f the thrombus can be used as evidence to discont...
...ndida Osteoarticular Infections...
...Osteomyelitis...
...e 400 mg (6 mg/kg) daily, for 6-12 mo...
...mulation AmB, 3-5 mg/kg daily, for ≥2 weeks fol...
...gical debridement is recommended in selected c...
...dida Septic Arthr...
...luconazole, 400 mg (6 mg/kg) daily, for 6 weeks O...
...tion AmB, 3-5 mg/kg daily, for 2 weeks,...
...rgical drainage is indicated in all cases of sep...
...c arthritis involving a prosthetic de...
If the prosthetic device cannot be removed, ch...
...andida Endophthalmitis...
...eneral Approach to Candida Endop...
...th candidemia should have a dilated...
For neutropenic patients it is recommende...
...ocular infection (chorioretinitis...
...garding antifungal treatment and surgical i...
...da Chorioretinitis WITHOUT V...
...nazole/voriconazole susceptible isolates,...
...fluconazole/voriconazole resistant...
...ular involvement, antifungal agents as noted abo...
...duration of treatment should be at...
...andida Chorioretinitis WITH Vitritis...
...therapy as detailed above for chorioretinitis w...
...should be considered to decrease the burden of...
...ion of treatment should be ≥4-6 week...
...I. Central Nervous System (CNS) Candidiasi...
...eatment, liposomal AmB, 5 mg/kg daily,...
...own therapy after the patient has responded to in...
...py should continue until all signs an...
...ted CNS devices, including ventriculo...
...ts in whom a ventricular device cannot...
...IV. Urinary Tract Infections Due to Candida...
...matic Candiduria...
Elimination of predisposing factors, suc...
...eatment with antifungal agents is not recommended...
...tropenic patients and very low birth...
...going urologic procedures should b...
...tomatic Candida Cystitis
...fluconazole-susceptible organisms,...
...zole-resistant C. glabrata, AmB de...
...C. krusei, AmB deoxycholate, 0.3-0.6 mg/kg dail...
...oval of an indwelling bladder catheter, if feasibl...
...e bladder irrigation, 50 mg/L sterile water da...
...ptomatic Ascending Candida Pyelonep...
...r fluconazole-susceptible organisms, or...
...resistant C. glabrata, AmB deoxycholate, 0....
...r fluconazole-resistant C. glabrata, monothe...
...rusei, AmB deoxycholate, 0.3-0.6 mg/kg daily,...
...urinary tract obstruction is strongly recommend...
...patients who have nephrostomy tubes or stents...
...ated with Fungus Balls...
...al intervention is strongly recommended i...
...ungal treatment as noted above for cystitis...
...ugh nephrostomy tubes, if present, with...
...ovaginal Candidiasi...
...ent of uncomplicated Candida vulvovaginitis, topi...
Alternatively, for the treatment of uncomplic...
...e Candida vulvovaginitis, fluconazol...
.... glabrata vulvovaginitis that is unre...
...ive agent for C. glabrata infection is ny...
...ption for C. glabrata infection is topical...
...curring vulvovaginal candidiasis, 10-14 days o...
...Oropharyngeal Candidiasis...
...e, clotrimazole troches, 10 mg 5 times dail...
...or mild disease include nystatin suspension, (100...
...moderate to severe disease, oral fluconazole,...
...luconazole-refractory disease, itra...
...es for fluconazole-refractory diseas...
...enous echinocandin (caspofungin, 70 mg loading dos...
...ressive therapy is usually unnecess...
...nfected patients, antiretroviral therapy is s...
...denture-related candidiasis, disinfection...
...Esophageal Candidiasis...
...ungal therapy is always required. A di...
...conazole, 200-400 mg (3-6 mg/kg) daily, for 14-...
...who cannot tolerate oral therapy: Intravenous flu...
...ed alternative for those who cannot tol...
...der de-escalating to oral therapy wi...
...conazole-refractory disease, itraconazol...
...ernatives for fluconazole-refractory...
...azole suspension, 400 mg twice daily, or exten...
...who have recurrent esophagitis, chr...
...-infected patients, antiretroviral therapy...