infectious diseases
Candidiasis
Treatment of Invasive Candidiasis
An echinocandin if patients are severely or critically ill or if infection withN. glabrata,C. auris, orP. kudriavzeviiis suspected Fluconazoleif patients are clinically stable, if infection withC. albicansorC. parapsilosisis suspected, or once antifungal susceptibilities become available Alternativelyvoriconazoleoramphotericin B (See also Antifungal Medications .) For candidemia and invasive candidiasis, initial treatment with an echinocandin and potential step-down tofluconazoleor another azole is recommended. In patients with invasive candidiasis, predisposing conditions (eg, neutropenia, immunosuppression, use of broad-spectrum antibacterial antibiotics, hyperalimentation, presence of indwelling lines) should be reversed or controlled if possible. In nonneutropenic patients, IV catheters should be removed. When an echinocandin is indicated (if patients are moderately severely ill or critically ill [most neutropenic patients] or ifN. glabrata,C. auris, orP. kudriavzeviiis suspected), one of the following medications can be used: Caspofungin Micafungin Anidulafungin Fluconazoleis indicated if patients are clinically stable, ifC. albicansorC. parapsilosisis suspected, or once antifungal susceptibilities become available. can be used ( Treatment reference ). Treatment of candidemia is continued for 14 days after the last negative blood culture. Esophageal candidiasis is treated with one of the following: Fluconazole Itraconazole If these medications are ineffective or if infection is severe, one of the following may be used: Voriconazole Posaconazole Isavuconazonium An echinocandin Treatment of esophageal candidiasis is continued for 14 to 21 days. 1.Pappas PG, Kauffman CA, Andes DR, et al: Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America.Clin Infect Dis62(4):e1–e50, 2016. doi: 10.1093/cid/civ933 