ID consultation is mandatory.
We particularly recommend patients with ocular symptoms, prolonged candidemia, and those who are intubated to undergo an ophthalmologic examination by an ophthalmologist to look for evidence of endophthalmitis.
Central intravenous catheters should be removed in patients with candidemia.
| Indication for Therapy | Causative Organisms | Antimicrobial Regimens |
|---|---|---|
| Non-neutropenic adult while awaiting speciation | C. albicans, C. tropicalis, and C. glabrata | caspofungin 70 mg IV load, followed by 50 mg IV q24h |
| amphotericin B liposomal 3-5 mg/kg IV q24h | ||
Initial therapy when Candida species has been identified (Note: therapy can be further tailored once sensitivities are available) |
C. albicans, C. tropicalis, and C. parapsilosis | fluconazole 800 mg IV/PO load, followed by fluconazole 400 mg IV/PO q24h |
| C. glabrata | caspofungin 70 mg IV load, then 50 mg IV q24h | |
| C. krusei, which is intrinsically resistant to fluconazole | caspofungin 70 mg IV load, then 50 mg IV q24h | |
| C. lusitaniae, which is commonly resistant to amphotericin B | fluconazole 800 mg IV/PO load, followed by fluconazole 400 mg IV/PO q24h |
Typical duration is 14 days after the first negative blood culture, as the patient has no metastatic complications and resolution of signs and symptoms of infection.
Blondel-Hill E, Fryters S, editors. Bugs and Drugs. Edmonton: Capital Health; 2006.
Dismukes WE. Introduction to Antifungal Drugs. Clin Infect Dis. 2000;30:653-7.
Pappas PG, Kauffman CA, Andes DR et al. Clinical Practice Guidelines for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:e1-e50.