eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Candidiasis: Treatment & Medication
Updated: Nov 20, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Treatment of candidal infections is primarily accomplished with appropriate antifungal drugs.2
Surgical Care
Remove the offending catheter in central venous catheter infection because attempts to treat the infection without its removal are largely unsuccessful and are accompanied by high morbidity and mortality.
Consultations
Consult an infectious disease specialist for patients suspected of having systemic candidal infections, especially in the host who is immunocompromised, and consult an ophthalmologist for suspected endophthalmitis in neonates.
Diet
No specific diet is required.
Activity
No restrictions are required.
Medication
Candidal infections are sensitive to a broad range of antifungal agents. Nystatin and one of the imidazoles are the most commonly used agents for oral or cutaneous candidiasis. Noting the resistance pattern in your area is important; fluconazole-resistant Candida has been reported. New antifungals include the echinocandins (eg, caspofungin, micafungin, anidulafungin). The mechanism of action of this group is to interfere with the cell wall integrity inhibiting 1,3 alpha-D-glucan synthase. Caspofungin has recently been approved by the US Food and Drug Administration (FDA) for use in the pediatric population.
Topical antifungals (oral preparations)
These agents are used for the treatment of oral candidiasis (thrush).
Nystatin oral suspension (Nilstat)
DOC for PO candidiasis. Fungicidal and fungistatic antibiotic obtained from Streptomyces noursei.
Adult
4-6 mL (ie, 400,000-600,000 U) PO swish and spit qid until 48 h after lesions resolve
Pediatric
Premature infants: 0.25-0.5 mL to each side of mouth qid until 48 h after lesions resolve
Infants: 1 mL to each side of mouth qid until 48 h after lesions resolve
Children: 2-3 mL to each side of mouth qid until 48 h after lesions resolve
1 mL=100,000 U
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Safe in breastfeeding because PO susp is poorly absorbed
Gentian violet
Effective as second-line agent for PO candidiasis resistant to nystatin.
Adult
Apply to affected areas tid
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Stains skin and clothing
Topical antifungals (dermatologic)
These agents are used to treat cutaneous candidiasis.
Nystatin cream (Mycostatin, Nilstat)
DOC in cutaneous candidiasis. Each gram of cream contains 100,000 U.
Adult
Apply bid/qid to affected areas until 48 h after resolution of lesions
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Not for treatment of systemic fungal infections; avoid contact with eyes; if irritation or sensitivity develops, discontinue use and institute appropriate therapy
Clotrimazole 1% cream (Lotrimin, Mycelex)
Second-line agent in treatment of cutaneous candidiasis.
Adult
Apply to affected area bid until 48 h after resolution of lesions
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Not for treatment of systemic fungal infections; avoid contact with eyes; if irritation or sensitivity develops, discontinue use and institute appropriate therapy
Miconazole 2% cream (Absorbine, Micatin)
Alternate topical antifungal. Lotion is preferred in intertriginous areas. If cream is used, apply sparingly to avoid maceration effects.
Adult
Apply to affected areas bid until 48 h after resolution of lesions
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
If sensitivity or chemical irritation occurs, discontinue use; use only externally; avoid contact with eyes
Systemic antifungals (oral)
These agents are used for treatment of cutaneous infections refractory to treatment by topical agents or as adjunctive therapy for systemic candidal infection.
Fluconazole oral (Diflucan)
Synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal CYP450 and sterol C-14 alpha-demethylation, which prevents conversion of lanosterol to ergosterol, thereby disrupting cellular membranes.
Adult
Vulvovaginitis: 150 mg PO once
Oropharyngeal and esophageal candidiasis: 200 mg PO on day 1, followed by 100 mg once daily
Pediatric
Oropharyngeal candidiasis: 6 mg/kg PO on day 1, followed by 3 mg/kg/d
Some older children may have clearances similar to that of adults; absolute doses not to exceed 600 mg/d
Systemic candidal infections: 6-12 mg/kg/d
Inhibits CYP2C19 and 3A4; levels may increase with hydrochlorothiazide; levels may decrease with chronic coadministration of rifampin; coadministration may decrease phenytoin clearance; may increase concentrations of theophylline, tolbutamide, glyburide, and glipizide; effects of anticoagulants may increase with coadministration; increases in cyclosporine concentrations may occur when administered concurrently
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose for renal insufficiency; monitor closely if rashes develop and discontinue drug if lesions progress; may cause clinical hepatitis, cholestasis, and fulminant hepatic failure (including death) with underlying medical conditions (eg, AIDS, malignancy) and while taking multiple concomitant medications; not recommended for mothers who are breastfeeding
Itraconazole (Sporanox)
Effective PO systemic antifungal. Fungistatic activity. Synthetic triazole antifungal agent that slows fungal cell growth by inhibiting CYP450-dependent synthesis of ergosterol, a vital component of fungal cell membranes.
Adult
Oral candidiasis: 100 mg PO once daily for 15 d Vulvovaginitis: 200 mg PO bid for 1-3 d
Pediatric
3-5 mg/kg/d PO divided qd/bid
Potent inhibitor of CYP3A4; antacids may reduce absorption of itraconazole; edema may occur with coadministration of calcium channel blockers (eg, amlodipine, nifedipine); hypoglycemia may occur with sulfonylureas; may increase tacrolimus and cyclosporine plasma concentrations when high doses are used; rhabdomyolysis may occur with coadministration of HMG-CoA reductase inhibitors (lovastatin or simvastatin); coadministration with cisapride can cause cardiac rhythm abnormalities and death; may increase digoxin levels; coadministration may increase plasma levels of midazolam, alprazolam, or triazolam; phenytoin and rifampin may reduce itraconazole levels (phenytoin metabolism may be altered)
Documented hypersensitivity; coadministration with cisapride may cause adverse cardiovascular effects (possibly death); coadministration with alprazolam and triazolam
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause nausea, vomiting, diarrhea, hypokalemia, and elevated transaminases; hepatic metabolism; does not penetrate CSF well
Ketoconazole (Nizoral)
Well absorbed PO. Administer with food to reduce nausea and vomiting. Imidazole broad-spectrum antifungal agent. Inhibits synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death.
Adult
Superficial candidal infection (PO, vaginal, esophageal): 200 mg PO once daily for 1-2 wk
Pediatric
<2 years: Not established
>2 years: 3.3-6.6 mg/kg/d PO once daily
Potent inhibitor of CYP3A4; isoniazid may decrease bioavailability; coadministration decreases effects of either rifampin or ketoconazole; may increase effect of anticoagulants; may increase toxicity of corticosteroids and cyclosporine (cyclosporine dosage can be adjusted); may decrease theophylline levels
Documented hypersensitivity; fungal meningitis
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Hepatotoxicity may occur; may reversibly decrease corticosteroid serum levels (adverse effects avoided with dose of 200-400 mg/d); administer antacid, anticholinergics, or H2 blockers at least 2 h after taking
Flucytosine (Ancobon)
Also known as 5-FC. Converted to fluorouracil after penetrating fungal cells. Inhibits RNA and protein synthesis. Active against Candida and Cryptococcus species and generally used in combination with amphotericin B.
Adult
50-150 mg/kg/d PO divided q6h
Pediatric
Neonates: 80-160 mg/kg/d PO divided q6h
Children: 50-150 mg/kg/d PO divided q6h
Amphotericin B may increase toxicity of flucytosine; cytosine may inactivate flucytosine
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Monitor CBC count, creatinine, alkaline phosphatase, AST, and ALT; may cause anemia, leukopenia, or thrombocytopenia; therapeutic levels 25-100 mg/L; adjust dose in renal failure
Posaconazole (Noxafil)
Triazole antifungal agent. Blocks ergosterol synthesis by inhibiting the enzyme lanosterol 14-alpha-demethylase and sterol precursor accumulation. This action results in cell membrane disruption. Available as oral susp (200 mg/5 mL). Indicated for prophylaxis of invasive Aspergillus and Candida infections in patients at high risk due to severe immunosuppression.
Adult
200 mg (5 mL) PO tid with food or liquid nutritional supplement to enhance absorption
Pediatric
<13 years: Not established
>13 years: Administer as in adults
Metabolized via UDP glucuronidation; P-gp efflux substrate; CYP3A4 inhibitor
UDP-G inducers (eg, rifabutin, phenytoin) and drugs that increase gastric pH (eg, cimetidine) decrease serum levels (avoid concomitant use unless benefit outweighs risk)
Inhibits CYP3A4 and may elevate serum levels of cyclosporine, tacrolimus, sirolimus, rifabutin, midazolam, phenytoin, calcium channel blockers (eg, nifedipine, bepridil), HMG-CoA reductase inhibitors (eg, lovastatin, pravastatin), ergot alkaloids, terfenadine, astemizole, cisapride, pimozide, halofantrine, quinidine, or vinca alkaloids (eg, vincristine, vinblastine)
Documented hypersensitivity; coadministration with ergot alkaloids; coadministration with CYP3A4 substrates likely to result in serious toxicities (eg, terfenadine, astemizole, cisapride, pimozide, halofantrine, quinidine)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Common adverse effects include nausea, vomiting, diarrhea, rash, hypokalemia, thrombocytopenia, and elevated liver enzyme levels; closely monitor patients with severe diarrhea or vomiting for breakthrough fungal infections; rare adverse events include arrhythmias caused by QTc prolongation, bilirubinemia, or liver function impairment; caution with preexisting cardiac risk factors (eg, history of arrhythmia, hypokalemia, hypomagnesemia); food improves absorption and provides optimal serum concentration; shake well before use; administer with measuring spoon provided in package; avoid if breastfeeding
Voriconazole oral (Vfend)
Used for primary treatment of invasive aspergillosis and salvage treatment of Fusarium species or Scedosporium apiospermum infections. A triazole antifungal agent that inhibits fungal CYP450-mediated 14 alpha-lanosterol demethylation, which is essential in fungal ergosterol biosynthesis.
Adult
<40 kg: 100 mg PO q12h, may increase to 150 mg q12h if inadequate response
>40 kg: 200 mg PO q12h, may increase to 300 mg q12h if inadequate response
Pediatric
Not established; limited data suggest initial maintenance dose of 3-5 mg/kg/dose PO q12h for children <25 kg
CYP450 2C19 (highest affinity), 2C9, and 3A4 (minor) substrate and inhibitor; CYP450 inducers (eg, rifampin) have shown to decrease steady state peak plasma levels by up to 93%; may increase serum levels of drugs metabolized by CYP450 2C19 or 2C9, of which some are contraindicated (eg, sirolimus, pimozide, quinidine, cisapride, ergot alkaloids), other may need more frequent monitoring (eg, cyclosporine, tacrolimus, warfarin, HMG CoA inhibitors, benzodiazepines, calcium channel blockers)
Documented hypersensitivity; do not administer IV form with CrCl <50 mL/min (decreased excretion of IV vehicle); coadministration with rifampin, rifabutin, carbamazepine, barbiturates, sirolimus, pimozide, quinidine, cisapride, ergot alkaloids
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Decrease maintenance dose with hepatic dysfunction; common adverse effects include visual disturbances, fever, rash, vomiting, nausea, diarrhea, headache, sepsis, peripheral edema, abdominal pain, rash (including Stevens-Johnson Syndrome and phototoxicity), and respiratory disorder; rare cases of severe hepatotoxicity have been reported; administer PO 1 h ac or pc
Systemic antifungals (intravenous)
The mechanism of action may involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to the fungal cell.
Fluconazole IV (Diflucan)
Second-line agent for treatment of systemic candidal infection.
Adult
400 mg IV as loading dose followed by 200 mg IV once daily
Pediatric
Neonates: 6-12 mg/kg IV as loading dose followed by 3-6 mg/kg/d once daily
Children: 10 mg/kg IV loading dose followed by 3-6 mg/kg/d once daily
Inhibits CYP3A4, thus increasing levels of CYP3A4 substrates (eg, may increase risk of cardiac arrhythmias by cisapride, astemizole); levels may increase with hydrochlorothiazide; levels may decrease with chronic coadministration of rifampin; coadministration may decrease phenytoin concentrations; may increase concentrations of theophylline, tolbutamide, glyburide, and glipizide; effects of anticoagulants may increase with coadministration; increases in cyclosporine concentrations may occur when administered concurrently
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose for renal insufficiency; monitor closely if rashes develop and discontinue drug if lesions progress; may cause clinical hepatitis, cholestasis, and fulminant hepatic failure (including death) with underlying medical conditions (eg, AIDS, malignancy) and while taking multiple concomitant medications; not recommended for mothers who are breastfeeding
Amphotericin B, liposome (AmBisome)
Amphotericin B in a 10% lipid emulsion appears to have less nephrotoxicity than standard preparation of amphotericin. Lipid emulsion does not appear to decrease antifungal properties of amphotericin B.
Adult
5 mg/kg IV as single infusion administered no faster than 2.5 mg/kg/h
Pediatric
Administer as in adults
Antineoplastic agents or other nephrotoxic drugs (eg, aminoglycosides, cyclosporine) may enhance potential of amphotericin B for renal toxicity, bronchospasm, and hypotension; corticosteroids, digitalis, and thiazides may potentiate hypokalemia
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Although less nephrotoxic than standard amphotericin preparations, use caution in patients with decreased renal function; monitor BUN and creatinine levels; LFT, electrolytes, and CBC count; may require premedication with antihistamines, corticosteroids or analgesics to decrease risk of headache, chills, fever, or rigors
Amphotericin B desoxycholate (Amphocin, Fungizone)
DOC for treatment of systemic fungal infections. Polyene antibiotic produced by strain of Streptomyces nodosus; can be fungistatic or fungicidal. Binds to sterols (eg, ergosterol) in fungal cell membrane, causing intracellular components to leak with subsequent fungal cell death.
Premedication with acetaminophen may help reduce rigors, chills, and fever associated with infusion. Hydrocortisone directly added to infusate also may reduce febrile reactions.
Adult
Test dose: 1 mg IV administered over 30 min
Initial dose: 0.25-0.5 mg/kg/d IV qd/qod administered over 2-6 h
Increment: Increase as tolerated by 0.25-0.5 mg/kg/d
Maintenance: 0.25-1 mg/kg/d or 1-1.5 mg/kg qod
Pediatric
Test dose: 0.1 mg/kg IV, not to exceed 1 mg; administer over 20-60 min
Initial dose: 0.25-0.5 mg/kg/d IV qd/qod administered over 2-6 h
Increment: Increase as tolerated by 0.25-0.5 mg/kg/d
Maintenance: 0.25-1 mg/kg/d or 1-1.5 mg/kg qod
Antineoplastic agents or other nephrotoxic drugs (eg, aminoglycosides, cyclosporine) may enhance potential of amphotericin B for renal toxicity, bronchospasm, and hypotension; corticosteroids, digitalis, and thiazides may potentiate hypokalemia
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Monitor renal function, serum electrolytes (eg, magnesium, potassium), LFT, CBC count, and hemoglobin concentrations; resume therapy at lowest level (eg, 0.25 mg/kg) when therapy is interrupted for >7 d; hypoxemia, acute dyspnea, and interstitial infiltrates may occur in patients who are neutropenic and who are receiving leukocyte transfusions (separate time of amphotericin infusion from time of leukocyte transfusion); fever and chills are common after first few administrations, premedication with antihistamines, corticosteroids, and analgesics may diminish reaction; rare acute reactions may include hypotension, bronchospasm, arrhythmias, and shock
Caspofungin (Cancidas)
First of a new class of antifungal drugs (glucan synthesis inhibitors). Inhibits synthesis of beta-(1,3)-D-glucan, an essential component of fungal cell wall.
Adult
50 mg IV qd
Pediatric
<3 months: Not established
3 months to 17 years:
Loading dose: 70 mg/m2 IV infused over 1 h on day 1
Maintenance: 50 mg/m2/d IV infused over 1 h
>18 years: Administer as in adults
Coadministration with cyclosporine may increase risk of hepatotoxicity; carbamazepine, nelfinavir, efavirenz, or dexamethasone may decrease levels of caspofungin; caspofungin may decrease levels of tacrolimus; rifampin decreases caspofungin levels by 30% (ie, adjust dose to 70 mg/d)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in moderate hepatic dysfunction (ie, decrease dose to 35 mg/d); may exacerbate pre-existing renal dysfunction or myelosuppression
Voriconazole IV (Vfend)
Used for primary treatment of invasive aspergillosis and salvage treatment of Fusarium species or Scedosporium apiospermum infections. A triazole antifungal agent that inhibits fungal CYP450-mediated 14 alpha-lanosterol demethylation, which is essential in fungal ergosterol biosynthesis. May be used as combination therapy in Candidemia
Adult
Loading dose: 6 mg/kg IV q12h infused over 2 h for 2 doses
Maintenance: 4 mg/kg IV q12h infused over 2 h, when able to tolerate, may switch to PO; if inadequate response, may increase to 300 mg q12h
Pediatric
Not established; in 2 reviews, the dosing recommended for invasive fungal disease was 6 mg/kg IV q12h for 2 doses, then 4 mg/kg IV q12h
Doses up to 8 mg/kg have also been used
>12 years: Administer as in adults
CYP450 2C19 (highest affinity), 2C9, and 3A4 (minor) substrate and inhibitor; CYP450 inducers (eg, rifampin) have shown to decrease steady state peak plasma levels by up to 93%; may increase serum levels of drugs metabolized by CYP450 2C19 or 2C9, of which some are contraindicated (eg, sirolimus, pimozide, quinidine, cisapride, ergot alkaloids), other may need more frequent monitoring (eg, cyclosporine, tacrolimus, warfarin, HMG CoA inhibitors, benzodiazepines, calcium channel blockers)
Documented hypersensitivity; do not administer IV form with CrCl <50 mL/min (decreased excretion of IV vehicle); coadministration with rifampin, rifabutin, carbamazepine, barbiturates, sirolimus, pimozide, quinidine, cisapride, ergot alkaloids
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Decrease maintenance dose with hepatic dysfunction; common adverse effects include visual disturbances, fever, rash, vomiting, nausea, diarrhea, headache, sepsis, peripheral edema, abdominal pain, rash (including Stevens-Johnson Syndrome and phototoxicity), and respiratory disorder; rare cases of severe hepatotoxicity have been reported; administer PO 1 h ac or pc
More on Candidiasis |
| Overview: Candidiasis |
| Differential Diagnoses & Workup: Candidiasis |
 Treatment & Medication: Candidiasis |
| Follow-up: Candidiasis |
| Multimedia: Candidiasis |
| References |
| « Previous Page | Next Page » |
References
Crislip MA, Edwards JE Jr. Candidiasis. Infect Dis Clin North Am. Mar 1989;3(1):103-33. [Medline].
Blyth CC, Palasanthiran P, O'Brien TA. Antifungal therapy in children with invasive fungal infections: a systematic review. Pediatrics. Apr 2007;119(4):772-84. [Medline].
Kaufman D, Boyle R, Hazen KC. Twice weekly fluconazole prophylaxis for prevention of invasive Candida infection in high-risk infants of <1000 grams birth weight. J Pediatr. Aug 2005;147(2):172-9. [Medline].
Kicklighter SD, Springer SC, Cox T, et al. Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics. Feb 2001;107(2):293-8. [Medline].
Long SS, Stevenson DK. Reducing Candida infections during neonatal intensive care: management choices, infection control, and fluconazole prophylaxis. J Pediatr. Aug 2005;147(2):135-41. [Medline].
Manzoni P, Arisio R, Mostert M. Prophylactic fluconazole is effective in preventing fungal colonization and fungal systemic infections in preterm neonates: a single-center, 6-year, retrospective cohort study. Pediatrics. Jan 2006;117(1):e22-32. [Medline].
[Best Evidence] Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, et al. A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med. Jun 14 2007;356(24):2483-95. [Medline].
Mondal RK, Singhi SC, Chakrabarti A, M J. Randomized comparison between fluconazole and itraconazole for the treatment of candidemia in a pediatric intensive care unit: a preliminary study. Pediatr Crit Care Med. Nov 2004;5(6):561-5. [Medline].
Alexander BD, Pfaller MA. Contemporary tools for the diagnosis and management of invasive mycoses. Clin Infect Dis. 2006;43:S15-27.
Bacheller CD, Bernstein JM. Urinary tract infections. Med Clin North Am. May 1997;81(3):719-30. [Medline].
Antifungal agents. In: Benitz WE, Tatro DS, eds. The Pediatric Drug Handbook. 3rd ed. St. Louis, Mo: Mosby; 1975.
Boiko S. Making rash decisions in the diaper area. Pediatr Ann. Jan 2000;29(1):50-6. [Medline].
Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 3rd ed. Baltimore, Md: Williams & Wilkins; 1990.
Denning DW, Evans EG, Kibbler CC, et al. Fungal nail disease: a guide to good practice (report of a Working Group of the British Society for Medical Mycology). BMJ. Nov 11 1995;311(7015):1277-81. [Medline].
Dodds Ashley ES, Lewis R, Lewis JS. Pharmacology of sytemic antifungal agents. Clin Infect Dis. 2006;43:S28-39.
du Vivier A, McKee PH, eds. Atlas of Clinical Dermatology. Philadelphia, Pa: WB Saunders; 1986.
Elder ME. T-cell immunodeficiencies. Pediatr Clin North Am. Dec 2000;47(6):1253-74. [Medline].
Elewski BE. Cutaneous mycoses in children. Br J Dermatol. Jun 1996;134 Suppl 46:7-11: discussion 37-8. [Medline].
Feja KN, Wu F, Roberts K, et al. Risk factors for candidemia in critically ill infants: a matched case-control study. J Pediatr. Aug 2005;147(2):156-61. [Medline].
Fidel PL Jr, Vazquez JA, Sobel JD. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans. Clin Microbiol Rev. Jan 1999;12(1):80-96. [Medline].
Harriet Lane Service, Children's Medical and Surgical Center, Johns Hopkins Hospital. Formulary. In: Siberry GK, Iannone R, eds. The Harriet Lane Handbook. 15th ed. St Louis, Mo: Mosby; 2000.
Hay RJ. The management of superficial candidiasis. J Am Acad Dermatol. Jun 1999;40(6 Pt 2):S35-42. [Medline].
Healy CM, Baker CJ, Zaccaria E. Impact of fluconazole prophylaxis on incidence and outcome of invasive candidiasis in a neonatal intensive care unit. J Pediatr. Aug 2005;147(2):166-71. [Medline].
Hoppe JE. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. Pediatr Infect Dis J. Sep 1997;16(9):885-94. [Medline].
Kauffman CA. The changing landscape of invasive fungal infections: epidemiology, diagnosis, and pharmacologic options. Clin Infect Dis. 2006;43:S1-2.
Legrand F, Lecuit M, Dupont B, Bellaton E, Huerre M, Rohrlich PS. Adjuvant corticosteroid therapy for chronic disseminated candidiasis. Clin Infect Dis. Mar 1 2008;46(5):696-702. [Medline].
Odio CM, Araya R, Pinto LE. Caspofungin therapy of neonates with invasive candidiasis. Pediatr Infect Dis J. Dec 2004;23(12):1093-7. [Medline].
Odom RB. Common superficial fungal infections in immunosuppressed patients. J Am Acad Dermatol. Sep 1994;31(3 Pt 2):S56-9. [Medline].
Pfaller MA, Pappas PG, Wingard JR. Invasive fungal pathogens: current epidemiological trends. Clin Infect Dis. 2006;43:S3-14.
Schwarze R, Penk A, Pittrow L. Administration of fluconazole in children below 1 year of age. Mycoses. Apr 1999;42(1-2):3-16. [Medline].
Singhi SC, Reddy TC, Chakrabarti A. Candidemia in a pediatric intensive care unit. Pediatr Crit Care Med. Jul 2004;5(4):369-74. [Medline].
Smith PB, Morgan J, Benjamin JD, et al. Excess costs of hospital care associated with neonatal candidemia. Pediatr Infect Dis J. Mar 2007;26(3):197-200. [Medline].
Smith PB, Steinbach WJ, Benjamin DK. Neonatal candidiasis. Infect Dis Clin North Am. Sep 2005;19(3):603-15. [Medline].
Steinbach WJ. Antifungal agents in children. Pediatr Clin North Am. Jun 2005;52(3):895-915, viii. [Medline].
Winston DJ, Pakrasi A, Busuttil RW. Prophylactic fluconazole in liver transplant recipients. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. Nov 16 1999;131(10):729-37. [Medline].
Working Group of the British Society for Medical Mycology. Management of genital candidiasis. BMJ. May 13 1995;310(6989):1241-4. [Medline].
Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94. [Medline].
Zaoutis TE, Heydon K, Localio R, Walsh TJ, Feudtner C. Outcomes attributable to neonatal candidiasis. Clin Infect Dis. May 1 2007;44(9):1187-93. [Medline].
Further Reading
Keywords
candidiasis, candidosis, monilia, thrush, Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida krusei, Candida lusitaniae, Candida stellatoidea, candidal infections, diaper dermatitis, intertrigo, diabetes mellitus, obesity, hyperhidrosis, total nail dystrophy, esophagitis, vaginal yeast infection, balanitis, balanoposthitis, acquired immunodeficiency syndrome, AIDS, very low birth weight premature infants, fungemia, endophthalmitis, meningitis, renal bezoars, arthritis, chronic mucocutaneous candidiasis, CMCC, necrotizing enterocolitis, vaginal candidosis, vulvovaginitis, cutaneous candidiasis, paronychia, onychomycosis, otitis externa, glossitis, hepatic candidiasis, liver abscesses, endocarditis
