Management of Candidiasis
Introduction to Candidiasis Management
- The Infectious Diseases Society of America recommends that management of candidiasis is site-specific and depends on disease severity, with oral fluconazole being the preferred systemic agent for most forms, while topical therapy suffices for mild mucocutaneous disease 1
Oropharyngeal Candidiasis
- The Infectious Diseases Society of America suggests clotrimazole troches 10 mg 5 times daily for 7-14 days as first-line treatment for mild oropharyngeal candidiasis 1, 2
- Miconazole mucoadhesive buccal 50-mg tablet applied once daily over the canine fossa for 7-14 days is equally effective for mild oropharyngeal candidiasis 1, 2
- For moderate to severe disease, the Infectious Diseases Society of America recommends oral fluconazole 100-200 mg daily for 7-14 days 1, 2
Vulvovaginal Candidiasis
- The Infectious Diseases Society of America states that topical antifungal agents are first-line for uncomplicated vulvovaginal candidiasis, with no single agent demonstrating superiority 1
Urinary Tract Candidiasis
- The Infectious Diseases Society of America recommends oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks for fluconazole-susceptible cystitis 1
- Removal of indwelling bladder catheter is strongly recommended if feasible for urinary tract candidiasis 1
Candidemia and Invasive Candidiasis
- The Infectious Diseases Society of America suggests empiric therapy should be initiated in critically ill patients with risk factors and no other fever source, with fluconazole 800-mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg) daily in ICUs with >5% invasive candidiasis rate 3, 4, 5
- Echinocandins are an alternative for empiric therapy, with caspofungin 70-mg loading dose then 50 mg daily; anidulafungin 200-mg loading dose then 100 mg daily; or micafungin 100 mg daily 3, 5
- Central venous catheter removal is strongly recommended for candidemia 6, 5
CNS Candidiasis
- The Infectious Diseases Society of America recommends amphotericin B deoxycholate 1 mg/kg IV daily for initial treatment of CNS candidiasis 6, 5
- Liposomal amphotericin B 5 mg/kg daily is an alternative for initial treatment of CNS candidiasis 6, 5
Intra-Abdominal Candidiasis
- The Infectious Diseases Society of America states that source control with drainage and/or debridement is mandatory for intra-abdominal candidiasis 3, 6, 5
Endocarditis
- The Infectious Diseases Society of America recommends lipid formulation amphotericin B 3-5 mg/kg daily with or without flucytosine 25 mg/kg 4 times daily OR high-dose echinocandin for initial therapy of endocarditis 6
- Valve replacement is recommended for endocarditis 6