Empiric Therapy Regimens for Suspected Candidiasis
Empiric therapeutic regimens for suspected candidiasis are outlined below, including those for neutropenic and nonneutropenic patients. [1, 2]
Nonneutropenic patients
Echinocandins are the drug of choice, including the following:
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Caspofungin 70 mg loading dose, then 50 mg daily or
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Micafungin 100 mg daily or
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Anidulafungin 200 mg loading dose, then 100 mg daily
Alternatives are as follows:
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Fluconazole 800 mg loading dose, then 400 mg daily or
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Lipid formulation of amphotericin B (LFAmB) 3-5 mg/kg IV daily or
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Amphotericin B deoxycholate (AmB-d) 0.5-1 mg/kg daily
For patients with moderately severe to severe illness and/or recent azole exposure, an echinocandin is preferred.
The duration of therapy is uncertain; discontinue therapy if cultures and/or serodiagnostic test results are negative.
Neutropenic patients
Echinocandins are the drug of choice, including the following:
-
Caspofungin 70 mg loading dose, then 50 mg daily or
-
Micafungin 100 mg daily or
-
Anidulafungin 200 mg loading dose, then 100 mg daily
Alternatives are as follows:
-
LFAmB 3-5 mg/kg IV daily plus caspofungin 70 mg loading dose, then 50 mg daily or
-
Voriconazole 400 mg (6 mg/kg) twice daily for 2 doses, then 200-300 mg twice daily or
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Fluconazole 800 mg loading dose, then 400 mg daily
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Generally, in neutropenic patients, it is appropriate to initiate empiric antifungal therapy after 4 days of persistent fever despite antibiotics.
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