Infectious Diseases Society of America Guidelines

Guidelines on the treatment of candidiasis by the Infectious Diseases Society of America are as follows^[39]:

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.

Medication

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Media Gallery

A moist, erosive, pruritic patch of perianal skin and perineum (with satellite pustule formation) is demonstrated in this woman with extensive candidiasis. Courtesy of Matthew C. Lambiase, DO.
Discrete superficial pustules developed within hours of birth on the hand of an otherwise healthy newborn. A potassium hydroxide preparation revealed spores and pseudomycelium, and culture demonstrated the presence of Candida albicans. Courtesy of Matthew C. Lambiase, DO.
Dry, red, superficially scaly, pruritic macules and patches on the penis represent candidal balanitis. Courtesy of Matthew C. Lambiase, DO.
White plaques are present on the buccal mucosa and the undersurface of the tongue and represent thrush. When wiped off, the plaques leave red erosive areas. Courtesy of Matthew C. Lambiase, DO.
Erythema, maceration, and satellite pustules in the axilla, accompanied by soreness and pruritus, result in a form of intertrigo. Courtesy of Matthew C. Lambiase, DO.
A nailfold with candidal infection becomes erythematous, swollen, and tender with occasional discharge. Courtesy of Matthew C. Lambiase, DO.
Soreness and cracks at the lateral angles of the mouth (angular cheilitis) are a frequent expression of candidiasis in elderly individuals. Courtesy of Matthew C. Lambiase, DO.
Fine, superficial pustules on an erythematous patchy base are suggestive of candidiasis. Courtesy of Matthew C. Lambiase, DO.
Candidal infection should be in the differential diagnosis when one or more nails become discolored, have subungual discoloration, have nailplate separation from the nailbed, and lack evidence of a dermatophyte. Courtesy of Matthew C. Lambiase, DO.
Candida dermatitis in the diaper area. Courtesy of Hon Pak, MD.

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Author

Jose A Hidalgo, MD Assistant Professor, Universidad Nacional Mayor de San Marcos; Attending Physician, Department of Internal Medicine, Division of Infectious Diseases, Guillermo Almenara Hospital, Peru

Jose A Hidalgo, MD is a member of the following medical societies: HIV Medicine Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Jose A Vazquez, MD, FACP, FIDSA Chief, Professor, Department of Medicine, Division of Infectious Diseases, Medical College of Georgia at Augusta University

Jose A Vazquez, MD, FACP, FIDSA is a member of the following medical societies: American Society for Microbiology, HIV Medicine Association, Immunocompromised Host Society, Infectious Diseases Society of America, International AIDS Society, International Immunocompromised Host Society, International Society for Human and Animal Mycology, International Society for Infectious Diseases, Medical Mycological Society of the Americas, Mycological Society of America, National Foundation for Infectious Diseases

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cidara; Amplyx; F2G, Scynexis<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan; Astellas.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

David Hall Shepp, MD Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine

David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Received salary from Gilead Sciences for management position.