Treatment of Candida Osteomyelitis

Diagnostic Considerations

The Infectious Diseases Society of America recommends that Candida osteomyelitis diagnosis should involve biopsy and culture, as mixed infections with bacteria are not uncommon, especially in adults and children with axial skeleton or long bones involvement 1
Candida albicans is the dominant pathogen, but non-albicans species are increasingly common, and their involvement can affect treatment choices 1

The treatment of Candida osteomyelitis requires surgical debridement combined with antifungal therapy, specifically fluconazole 400 mg (6 mg/kg) daily for 6-12 months or an echinocandin for at least 2 weeks followed by fluconazole for 6-12 months, as recommended by the Infectious Diseases Society of America 1
Surgical debridement of the affected area is essential, especially for vertebral osteomyelitis, and provides definitive histopathological and microbiological documentation before initiating prolonged therapy 1, 2
Antifungal therapy options include fluconazole 400 mg (6 mg/kg) daily for 6-12 months, an echinocandin for at least 2 weeks followed by fluconazole, or initial course of amphotericin B followed by fluconazole, with the choice depending on the susceptibility of the Candida species 1, 3, 4

Cure rates are significantly higher when antifungal therapy is administered for at least 6 months, and for Candida mediastinitis and sternal osteomyelitis after sternotomy, surgical debridement followed by antifungal therapy is recommended 1
The addition of amphotericin B or fluconazole to bone cement may be valuable as adjunctive therapy in complicated cases, though this practice remains controversial 1, 2

Regular clinical assessment for resolution of symptoms and signs, and radiographic imaging to document resolution of bone lesions, are essential for monitoring treatment response 1, 3
For patients with prosthetic joint infections, removal of the infected device is typically necessary, and if the prosthetic device cannot be removed, chronic suppression with fluconazole is recommended 2