IDSA GUIDELINES Bundle (free trial)

Candida Infections of the Cardiovascular System Condition Primary Endocarditis LFAmB 3-5 mg/kg +/- 5-FC 25 mg/kg qid or AmB-d 0.6-1 mg/kg daily +/- 5-FC 25 mg/kg qid or an echinocandin* (B-III) Alternative Step-down therapy to fluconazole 400-800 mg (6-12 mg/kg) daily for susceptible organism in stable patient with negative blood cultures (B-III) Pericarditis, myocarditis LFAmB 3-5 mg/kg daily, or fluconazole 400-800 mg (6-12 mg/kg) daily, or an echinocandin* (B-III) Suppurative thrombo-phlebitis LFAmB 3-5 mg/kg daily, or fluconazole 400-800 mg (6-12 mg/kg) daily, or an echinocandin* (B-III) Infected pacemakers, ICD, VAD LFAmB 3-5 mg/kg +/- 5-FC 25 mg/kg qid or AmB-d 0.6-1 mg/kg daily +/- 5-FC 25 mg/kg qid or an echinocandin* (B-III) Aſter stable, step- down to fluconazole 400-800 mg (6-12 mg/kg) daily (B-III) Aſter stable, step- down to fluconazole 400-800 mg (6-12 mg/kg) daily (B-III) Step-down therapy to fluconazole 400-800 mg (6-12 mg/kg) daily for susceptible organism in stable patient with negative blood cultures (B-III) Comments Valve replacement strongly recommended. If unable to remove valve, chronic suppression fluconazole 400-800 mg (6-12 mg/kg) daily. Life-long suppressive therapy for prosthetic valve endocarditis if valve cannot be replaced. Therapy for several months but little data. Pericardial window or pericardiectomy recommended. Catheter removal essential Surgical incision and drainage or resection of vein if feasible. Treat for at least 2 wk aſter candidemia has cleared. Removal of pacemakers and ICD. Treat for 4-6 weeks aſter device removed. For VAD that cannot be removed, chronic suppressive therapy with fluconazole is recommended. * For patients with endocarditis and other cardiovascular infections, higher daily doses of an echinocandin may be appropriate, eg, caspofungin 50-150 mg/d, micafungin 100-150 mg/d, anidulafungin 100-200 mg/d. Candida Osteoarticular Infections Condition Primary Osteomyelitis Fluconazole 400 mg (6 mg/kg)/d for 6-12 mo or LFAmB 3-5 mg/kg daily for several wk, then fluconazole for 6-12 mo (B-III) Septic arthritis Fluconazole 400 mg (6 mg/kg)/d for at least 6 wk or LFAmB 3-5 mg/kg daily for several wks, then fluconazole to completion (B-III) Alternative An echinocandin* or AmB-d 0.5-1 mg/kg daily for several wks, then fluconazole for 6-12 mo (B-III) An echinocandin** or AmB-d 0.5-1 mg/kg daily for several wks, then fluconazole to completion (B-III) Comments Duration of therapy usually is prolonged (6-12 months). Surgical debridement is frequently necessary. Duration of therapy usually for at least 6 wk, but few data are available. Surgical debridement recommended for all cases. Prosthetic joint removal 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.

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