Treatment of Fungal Infections

Treatment by Infection Location

The Infectious Diseases Society of America recommends fluconazol oral 200-400 mg diarios during 14-21 días for systemic or gastrointestinal fungal infections, while for localized infections such as vulvovaginitis, fluconazol 150 mg in a single dose or topical azole agents for 3-7 días are recommended 1, 2
For gastrointestinal candidiasis, fluconazol oral 200-400 mg (3-6 mg/kg) diarios during 14-21 días is the first-line treatment 2
For patients who cannot tolerate oral therapy, fluconazol intravenous 400 mg (6 mg/kg) diario is recommended 2
Alternative treatments for patients who cannot receive fluconazol include echinocandins (micafungin 150 mg/day, caspofungin 70 mg loading dose followed by 50 mg/day, or anidulafungin 200 mg/day) 2, 3

For uncomplicated vulvovaginal candidiasis, topical azole agents (clotrimazole, miconazole, etc.) for 3-7 días or fluconazol oral 150 mg in a single dose are recommended 4, 5
For severe vulvovaginal candidiasis, fluconazol 150 mg every 72 hours for 2-3 doses is recommended 4
For C. glabrata-resistant infections, boric acid intravaginal in gelatin capsules, 600 mg diarios during 14 días is recommended 4

For mild disease, clotrimazole lozenges 10 mg 5 times a day or miconazole buccal tablets 50 mg once a day for 7-14 días are recommended 6
For moderate to severe disease, fluconazol oral 100-200 mg diarios during 7-14 días is recommended 6
Alternative treatments include nystatin suspension (100,000 U/mL) 4-6 mL 4 times a day or nystatin tablets (200,000 U each) 4 times a day for 7-14 días 1

For fluconazol-resistant infections, itraconazol solution 200 mg diarios or voriconazol 200 mg (3 mg/kg) twice a day for 14-21 días are recommended 2, 3
Echinocandins (micafungin, caspofungin, or anidulafungin) for 14-21 días are also recommended 2
Amphotericin B deoxycholate 0.3-0.7 mg/kg diarios during 21 días is an alternative treatment 2

For symptomatic urinary tract infections, fluconazol 200 mg (3 mg/kg) diarios during 2 weeks is recommended 7
For pyelonephritis, fluconazol 200-400 mg (3-6 mg/kg) diarios during 2 weeks is recommended 7
For patients with fungal balls in the urinary tract, surgical removal along with systemic antifungal therapy is recommended 7
For recurrent vulvovaginal candidiasis, induction therapy with a topical agent or fluconazol oral for 10-14 días, followed by fluconazol 150 mg weekly for 6 months is recommended 4
For recurrent esophagitis, chronic suppressive therapy with fluconazol 100-200 mg 3 times a week is recommended 2

It is essential to confirm the diagnosis through microscopic identification of fungi before starting treatment 5, 8
In immunocompromised patients, especially those with HIV, antiretroviral therapy is recommended in addition to antifungal treatment 2, 8
The duration of treatment for systemic infections should be based on clinical and microbiological response 9