s balls
eonate)
Non-Neutropenic Initial Therapy
for Adult and Pediatric Patients
(obtain culture & remove intravenous catheter [A-II])
Moderate to severe
illness or recent azole
exposure
NO
Fluconazole, loading dose
800 mg (12 mg/kg) then
400 mg (6 mg/kg) daily
(A-I)
YES
Echinocandin
(caspofungin 70 mg load, then 50 mg daily;
micafungin 100 mg daily; anidulafungin 200 mg
load, then 100 mg daily) is recommended as initial
therapy for most adult patients (A-I).
Culture
Result
gical
ention
mended
us
nazole
C. albicans
C. tropicalis
renal
ystem
gation
d is
ed
C. parapsilosis
Fluconazole is
recommended
(B-III)
Fluconazole is
recommended
For patients who
have initially
received an
echinocandin, are
clinically improved,
and whose follow
up cultures
are negative,
continuing an
echinocandin is
reasonable (B-III)
C. glabrata
Echinocandin is preferred
(B-III)
transition to fluconazole
or voriconazole is not
recommended without
confirmation of isolate
susceptibility (B-III)
For patients who have
initially received fluconazole
or voriconazole, are
clinically improved, and
whose follow up cultures
are negative, continuing
an azole to completion of
therapy is reasonable (B-III)
Duration of therapy for candidemia without
obvious metastatic complications:
2 weeks following documented clearance of
Candida from the bloodstream and resolution of
symptoms attributable to candidemia (A-III)
3
