Key Points
ÎAll candidemic patients should undergo a dilated ophthalmologic exam
ÎAntifungal therapy should be started within 24 hours of a positive blood culture for yeast
ÎFollow-up blood cultures should be obtained on all patients with candidemia to insure clearance
ÎFor 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.
ÎFor 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.
