Key Points
ÎÎAll candidemic patients should undergo a dilated
ophthalmologic exam
ÎÎAntifungal therapy should be started within 24 hours of a
positive blood culture for yeast
ÎÎFollow-up blood cultures should be obtained on all
patients with candidemia to insure clearance
ÎÎFor Candidemia in non-neutropenic patients
>> In both children and adults use fluconazole for mild illness;
an echinocandin for moderate to severe illness or if recent
exposure to an azole; AmB-d or LFAmB are alternatives.
Duration of therapy for candidemia without obvious metastatic
complications is 2 weeks following clearance of Candida from
blood stream and resolution of symptoms; IV catheter removal
recommended.
>> Empirical therapy for suspected candidiasis in non-neutropenic
patients is similar to that for proven candidiasis. Consider this if
critically ill with risk factors for invasive candidiasis and no other
known cause of fever.
ÎÎFor Candidemia in neutropenic patients
>> Echinocandins or LFAmB are recommended. Fluconazole
is alternative if less critically ill and no recent azole use.
Treat candidemia without persistent fungemia or metastatic
complications until 2 weeks after clearance of Candida from
bloodstream and resolution of symptoms attributable to
candidemia and resolution of neutropenia. IV catheter removal
should be considered.
>> Empirical treatment for invasive candidiasis in neutropenic
patients is LFAmB, caspofungin, or voriconazole. Fluconazole
and itraconazole are alternatives.
