Treatment of Candida lusitaniae Infections

Antifungal Options for C. lusitaniae

The Infectious Diseases Society of America recommends fluconazole as the preferred first-line therapy for Candida lusitaniae infections due to its effectiveness against this species and the known resistance patterns 1, 2
Fluconazole 6 mg/kg daily is the standard adult dose for C. lusitaniae infections, but for severe infections, consider starting with fluconazole 12 mg/kg daily to ensure adequate drug levels 1
Echinocandins, such as caspofungin, micafungin, or anidulafungin, are effective alternatives when fluconazole cannot be used or in critically ill patients 3
Lipid formulation amphotericin B should be used with extreme caution due to the high likelihood of resistance 4, 5

C. lusitaniae is well-known for its ability to rapidly develop resistance to amphotericin B, which is a unique characteristic of this species 4, 5
Not all C. lusitaniae isolates are resistant to amphotericin B, but resistance is common enough that amphotericin B should not be used as first-line therapy 4, 5
For candidemia without metastatic complications, treat for 14 days after documented clearance of Candida from the bloodstream and resolution of symptoms 6
For deep-seated infections, longer treatment courses may be necessary until all signs, symptoms, and radiological abnormalities have resolved 6
Removal of infected central venous catheters is strongly recommended for candidemia 6
For intra-abdominal infections, appropriate drainage and/or debridement is essential 3, 7

Obtain cultures and initiate empiric therapy with fluconazole 6-12 mg/kg daily 1, 2
For critically ill patients, consider starting with an echinocandin, such as caspofungin, anidulafungin, or micafungin 3, 6
Continue treatment for at least 14 days after clearance of infection and resolution of symptoms 6

In neonates with disseminated candidiasis, fluconazole 12 mg/kg daily is recommended if C. lusitaniae is isolated 6
For severe neonatal infections, consider starting with fluconazole rather than amphotericin B due to the risk of resistance 6
Echinocandins should be used with caution in neonates and generally limited to salvage therapy 6

Assuming all Candida species have similar susceptibility patterns can lead to treatment failure with C. lusitaniae 4, 5