Central Nervous System Candidiasis Primary
Alternative
LFAmB 3-5 mg/kg +/- 5-FC 25 mg/kg qid for several wks, followed by fluconazole, 400-800 mg (6-12 mg/kg) daily (B-III)
Only when there is a specific contraindication to the use of LFAmB should fluconazole, 400-800 mg (6-12 mg/kg) daily, be considered for primary therapy.
Candida Endophthalmitis
AmB-d 0.7-1 mg/kg +5-FC 25 mg/kg qid (A-III) or fluconazole 6-12 mg/kg daily (B-III) Surgical intervention for patients with severe endophthalmitis or vitreitis (B-III)
LFAmB 3-5 mg/kg daily; voriconazole 6 mg/kg q12h for two doses, then 3-4 mg/kg q12h; or an echinocandin** (B-III)
Therapy x 4-6 wks as determined by repeated examinations to verify resolution. Diagnostic vitreal aspiration should be done if etiology unknown.
Comments
Treat until all signs and symptoms, cerebrospinal fluid (CSF) abnormalities, and radiologic abnormalities have resolved. Removal of intraventricular devices is recommended.
**Echinocandin dosing in adults is anidulafungin, 200 mg loading then 100 mg/d, caspofungin, 70 mg loading then 50 mg/d, and micafungin, 100 mg/d.
Oropharyngeal Candidiasis
Clotrimazole troches 10 mg 5 times daily; nystatin suspension or pastilles qid (B-II); or fluconazole 100-200 mg daily (A-I)
Itraconazole solution 200 mg daily; or posaconazole 400 mg daily (A-II); voriconazole 200 mg bid; or AmB oral suspension (B-II); IV echinocandin** or AmB-d 0.3 mg/kg daily (B-II)
Fluconazole for moderate to severe disease; topical therapy with clotrimazole or nystatin for mild disease. Treat uncomplicated disease for 7-14 d. For refractory disease, itraconazole solution, voriconazole, posaconazole or AmB suspension, and rarely AmB-d or echinocandins is recommended.
**Echinocandin dosing in adults is anidulafungin, 200 mg loading then 100 mg/d, caspofungin, 70 mg loading then 50 mg/d, and micafungin, 100 mg/d.
Chronic Disseminated Candidiasis
Fluconazole 400 mg (6 mg/kg) daily for stable patients (A-III) LFAmB 3-5 mg/kg daily or AmB-d 0.5-0.7 mg/kg daily for severely ill patients (A-III) When stable, change to fluconazole (B-III)
An echinocandin for several wks followed by fluconazole (B-III)
Transition from LFAmB or AmB-d to fluconazole is favored aſter several wks in stable patients. Duration of therapy is until lesions resolve (usually months) and should continue through periods of immunosuppression (chemotherapy, transplantation).
Candida Isolated from Respiratory Secretions
Therapy not recommended (A-III) Candida lower respiratory tract infection is rare and requires histopathologic evidence to confirm a diagnosis
