Candidiasis Guidelines

Updated: Nov 04, 2016
  • Author: Jose A Hidalgo, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Guidelines

Infectious Diseases Society of America Guidelines

Guidelines on the treatment of candidiasis by the Infectious Diseases Society of America are as follows: [27]

  • The IDSA recommends an echinocandin as first-line treatment for candidemia (caspofungin: loading dose 70 mg, then 50 mg daily; micafungin: 100 mg daily; anidulafungin: loading dose 200 mg, then 100 mg daily), rather than fluconazole, as echinocandins kill, rather than inhibit, these pathogens.
  • Fluconazole, intravenous or oral, 800 mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg) daily is an acceptable alternative to an echinocandin as initial therapy in selected patients, including those who are not critically ill and who are considered unlikely to have a fluconazole-resistant Candida species.
  • In neutropenic patients, lipid formulation amphotericin B, 3-5 mg/kg daily, is an effective but less attractive alternative because of the potential for toxicity.
  • Fluconazole could be used in high-risk patients in adult ICUs with a high rate (>5%) of invasive candidiasis.
  • Daily bathing of ICU patients with chlorhexidine, which has been shown to decrease the incidence of bloodstream infections including candidemia, could be considered.
  • The updated guidelines also advocate consultation with infectious disease specialists for the early identification of different Candida strains, optimal antifungal treatment, and better patient outcomes.
  • The guidelines advocate testing for azole susceptibility in clinically relevant Candida isolates. Testing for echinocandin susceptibility should be considered in patients who have undergone prior treatment with an echinocandin and in those with C glabrata or C parapsilosis infection.
  • Candidiasis should be considered in patients who deteriorate with no obvious cause, have unexplained fever, have an elevated white blood cell count, have recently undergone abdominal surgery, or have a central venous catheter.
  • Remove a catheter as early as possible in patients with candidemia if the catheter is the presumed source and can be safely removed. Other intravascular devices should also be removed.
  • For neonatal candidiasis, amphotericin B deoxycholate 1 mg/kg daily is recommended for neonates with disseminated candidiasis.
  • Lumbar puncture and dilated retinal examination are recommended in neonates with serum or urine cultures that are positive for Candida species .
  • Empiric antifungal therapy should be considered in patients with clinical evidence of intra-abdominal infection and significant risk factors for candidiasis, including recent abdominal surgery, anastomotic leaks, or necrotizing pancreatitis.