Candidiasis Empiric Therapy

Updated: Jan 23, 2023
Author: Jose A Vazquez, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD 

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:

Alternatives are as follows:

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:

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
  • Fluconazole 800 mg loading dose, then 400 mg daily
  • Generally, in neutropenic patients, it is appropriate to initiate empiric antifungal therapy after 4 days of persistent fever despite antibiotics.