Candida

Last updated April 8, 2022

Key Points

Key Points

Invasive infection due to Candida species is largely a condition associated with medical progress and is widely recognized as a major cause of morbidity and mortality in the healthcare environment.

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

...Manageme...

...I. Candidemia in N...

...din (caspofungin, loading dose 70 mg, then 50 mg d...

...le intravenous or oral, 800 mg (12...

...le susceptibility is recommended for all bloods...

...m an echinocandin to fluconazole (usu...

...n due to C. glabrata, transition to higher-dose fl...

...d formulation amphotericin B (AmB) (3-5 mg/kg...

...om AmB to fluconazole is recommended after 5-7 day...

...ng patients with suspected azole and echinocandin...

...oriconazole 400 mg (6 mg/kg) twice daily f...

...oriconazole is recommended as step-down ora...

...-neutropenic patients with candide...

...-up blood cultures should be performed ever...

...ended duration of therapy for candi...


...II. Central Ven...

...be removed as early as possible in the...


...III. Candidemia in...

...echinocandin (caspofungin, loading dose...

...d formulation AmB, 3-5 mg/kg daily, is an eff...

...zole, 800 mg (12 mg/kg) loading dose,...

...0 mg (6 mg/kg) daily, can be used f...

...conazole, 400 mg (6 mg/kg) twice daily for...

...ole can also be used as step-down...

For infections due to C. krusei, an echinocand...

...d minimum duration of therapy for candi...

...ogical findings of choroidal and vitreal...

...ropenic patient, sources of candidia...

...mobilized granulocyte transfusions can be...


...IV. Chronic Disseminated...

...tial therapy with lipid formulation AmB, 3-5 mg...

Therapy should continue until lesions resolve on r...

...therapy or hematopoietic cell transp...

...patients who have debilitating persiste...


...V. Empirica...

...antifungal therapy should be considered in criti...

...pirical antifungal therapy should be st...

...d empirical therapy for suspected candidiasis i...

...uconazole, 800 mg (12 mg/kg) loading dose, th...

...formulation AmB, 3-5 mg/kg daily, is an altern...

...commended duration of empirical therapy for sus...

...s who have no clinical response to empirical a...


...VI. Prophylaxis to Pr...

...ole, 800 mg (12 mg/kg) loading dose, th...

...n alternative is to give an echinocand...

Daily bathing of ICU patients with chlorhexid...


...VII. N...

...Invas...

...ycholate, 1 mg/kg daily, is recommended for neonat...

..., 12 mg/kg IV or oral daily, is a reason...

...formulation AmB, 3-5 mg/kg daily, is...

...dins should be used with caution and generally...

...re and a dilated retinal examination are recomme...

...asound imaging of the genitourinary tract, liver...

...catheter removal is strongly recomm...

...mmended duration of therapy for ca...

...CNS infections in Neon...

...reatment, AmB deoxycholate, 1 mg/kg IV daily, is...

...ive regimen is liposomal AmB, 5 mg/kg daily. ( S...

...addition of flucytosine, 25 mg/kg 4 times daily...

For step-down treatment after the p...

...y should continue until all signs, sympto...

...devices, including ventriculostomy drains and...

...Prophylaxis in t...

...ith high rates (>10%) of invasive candidiasis, int...

...100,000 units 3 times daily for 6 weeks,...

...bovine lactoferrin (100 mg/day) ma...


...cal antifungal therapy should be considered for pa...

...ntra-abdominal candidiasis should i...

...f antifungal therapy is the same as for...

...of therapy should be determined by adequacy of so...


...IX. Candida...

...of Candida from respiratory secreti...


...X. Candida Intrav...

...Candida Endoca...

...ive valve endocarditis, lipid formu...

...apy to fluconazole, 400-800 mg (6-12 mg/kg) da...

...riconazole, 200-300 mg (3-4 mg/kg) twice da...

...alve replacement is recommended. Treatment should...

...ients who cannot undergo valve rep...

...rosthetic valve endocarditis, the same a...

...hronic suppressive antifungal therapy wit...

...Candid...

...r pacemaker and implantable cardiac defi...

...ungal therapy is the same as that recommended f...

...r infections limited to generator pockets, 4 we...

...ctions involving the wires, ≥6 w...

...cular assist devices that cannot be remov...

...ive therapy with fluconazole if the isolate i...

...Candida Suppurative Th...

...theter removal and incision and dra...

...formulation AmB, 3-5 mg/kg daily, O...

...p-down therapy to fluconazole, 400-800 mg (6-12...

...on of the thrombus can be used as...


...XI. Candida Osteoart...

...Candida Osteomye...

...400 mg (6 mg/kg) daily, for 6-12 months OR a...

...rmulation AmB, 3-5 mg/kg daily, for ≥2...

...cal debridement is recommended in selected ca...

...Candida Septic Arthr...

...00 mg (6 mg/kg) daily, for 6 weeks OR an e...

...id formulation AmB, 3-5 mg/kg dail...

...drainage is indicated in all cases of septic art...

...rthritis involving a prosthetic device, device rem...

...osthetic device cannot be removed, chronic supp...


...XII....

...General Appro...

...nts with candidemia should have a dilated r...

...r neutropenic patients it is recomme...

...extent of ocular infection (chorioretinit...

...regarding antifungal treatment and surgical...

...Candida...

...ole/voriconazole susceptible isolates, fluconazo...

...ole/voriconazole resistant isolates, liposom...

...involvement, antifungal agents as noted ab...

...n of treatment should be at least 4-6 we...

...Candida Chor...

Antifungal therapy as detailed above for chorioret...

...tomy should be considered to decrease the...

...ion of treatment should be ≥4-6...


...XII...

...ial treatment, liposomal AmB, 5 mg/kg d...

For step-down therapy after the pa...

...herapy should continue until all signs and sy...

...ed CNS devices, including ventriculos...

...patients in whom a ventricular device ca...


...XIV. Urinar...

...Asymptomatic Can...

...redisposing factors, such as indwelling bl...

...nt with antifungal agents is not recommended...

...openic patients and very low birth weight...

...ergoing urologic procedures should be treated wit...

...Symp...

...conazole-susceptible organisms, oral fluconazole,...

...or fluconazole-resistant C. glabrata, AmB...

...AmB deoxycholate, 0.3-0.6 mg/kg da...

...indwelling bladder catheter, if feasible, is...

...ycholate bladder irrigation, 50 mg/...

...Symptomatic A...

...luconazole-susceptible organisms, oral fluconaz...

...resistant C. glabrata, AmB deoxycholate,...

...resistant C. glabrata, monotherapy with oral...

...krusei, AmB deoxycholate, 0.3-0.6 mg/kg daily,...

...rinary tract obstruction is strongly r...

...ients who have nephrostomy tubes or...

...UTI Associa...

...al intervention is strongly recommended...

...atment as noted above for cystitis or pye...

Irrigation through nephrostomy tubes, if pre...


...XV. Vulvovaginal Candidi...

...the treatment of uncomplicated Candida vulvo...

Alternatively, for the treatment of uncomplic...

...re acute Candida vulvovaginitis, fluconazo...

.... glabrata vulvovaginitis that is unrespon...

...alternative agent for C. glabrata...

...ird option for C. glabrata infecti...

...ulvovaginal candidiasis, 10-14 days o...


...XVI. Oropharyn...

...ild disease, clotrimazole troches, 1...

...lternatives for mild disease include...

...derate to severe disease, oral fluconazole, 1...

...uconazole-refractory disease, itraconazol...

...natives for fluconazole-refractory disease i...

...ravenous echinocandin (caspofungin, 70...

...onic suppressive therapy is usually unnece...

...cted patients, antiretroviral ther...

...denture-related candidiasis, disinfection...


...XVI...

...antifungal therapy is always required. A dia...

...l fluconazole, 200-400 mg (3-6 mg/kg) daily,...

...nts who cannot tolerate oral therapy: Int...

...eferred alternative for those who c...

...escalating to oral therapy with fluconazole 20...

...zole-refractory disease, itraconazole sol...

...rnatives for fluconazole-refractory disease i...

...nazole suspension, 400 mg twice daily, or e...

...atients who have recurrent esophagitis, chro...

...fected patients, antiretroviral therapy is...