Non-Neutropenic Initial Therapy for Adult and Pediatric Patients
(obtain culture & remove intravenous catheter [A-II])
NO
Moderate to severe illness or recent azole exposure
YES
s balls eonate)
Fluconazole, loading dose 800 mg (12 mg/kg) then 400 mg (6 mg/kg) daily (A-I)
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).
gical
ention mended us
nazole
C. albicans C. tropicalis
renal ystem gation d is ed
C. parapsilosis C. glabrata
Culture Result
Fluconazole is
recommended (B-III)
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 an
Fluconazole is recommended
echinocandin, are
clinically improved, and whose follow up cultures
are negative, continuing an echinocandin is reasonable (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)
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