Medical Care

Treatment of candidal infections is primarily accomplished with appropriate antifungal drugs. Mild to moderate infection is initially empirically treated with fluconazole while severe infection is treated with a combination of fluconazole plus liposomal amphotericin B.^[6]

Today, neonatal intensive care units (NICUs) in most centers are routinely starting fluconazole prophylaxis in very low birth weight neonates and those with other risk factors to prevent invasive candidiasis.^{[7, 8, 9, 10]}

A study compared the safety and efficacy outcomes of micafungin between prematurely and non-prematurely born infants < 2 years of age. The study concluded that micafungin has a safe profile in premature and non-premature infants with substantial efficacy.^[11]

The Infectious Diseases Society of America (IDSA) updated their guidelines for managing Candida infections by recommending first-line treatment for candidemia with an echinocandin ( such as caspofungin, micafungin, or anidulafungin), rather than fluconazole, as echinocandins kill, rather than inhibit, these pathogens.^{[12, 13]}

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.

Prevention

As invasive candidiasis is a cause of sepsis in premature infants, a review of randomized, placebo-controlled trials evaluated fluconazole prophylaxis in premature infants. The study reported that fluconazole prophylaxis reduced the odds of invasive candidiasis and death (odds ratios of 0.48 [95% CI, .30-.78]), invasive candidiasis (0.20 [95% CI, .08-.51]) and Candida colonization (0.28 [95% CI, .18-.41]) compared to the placebo.^[14]

Medication

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Media Gallery

Typical appearance of thrush. Note multiple white plaques on lips, gingivae, tongue, and palate.
Candidal diaper dermatitis. Note satellite papules and involvement of intertriginous folds.