9
Î For fluconazole/voriconazole resistant isolates, liposomal AmB,
3-5 mg/kg IV daily, with or without oral flucytosine, 25 mg/kg 4 times
daily is recommended (S/L).
Î With macular involvement, antifungal agents as noted above PLUS
intravitreal injection of either AmB deoxycholate, 5-10 μg/0.1 mL
sterile water, or voriconazole, 100 μg/0.1 mL sterile water or
normal saline, to ensure a prompt high level of antifungal activity is
recommended (S/L).
Î The duration of treatment should be at least 4-6 weeks, with the final
duration depending on resolution of the lesions as determined by
repeated ophthalmological examinations (S/L).
Candida Chorioretinitis WITH Vitritis
Î Antifungal therapy as detailed above for chorioretinitis without vitritis,
PLUS intravitreal injection of either AmB deoxycholate, 5-10 μg/0.1 mL
sterile water, or voriconazole, 100 μg/0.1 mL sterile water or normal
saline is recommended (S/L).
Î Vitrectomy should be considered to decrease the burden of organisms
and to allow the removal of fungal abscesses that are inaccessible to
systemic antifungal agents (S/L).
Î The duration of treatment should be ≥4-6 weeks, with the final
duration dependent on resolution of the lesions as determined by
repeated ophthalmological examinations (S/L).
XIII. Central Nervous System (CNS) Candidiasis
Î For initial treatment, liposomal AmB, 5 mg/kg daily, with or without
oral flucytosine, 25 mg/kg 4 times daily is recommended (S/L).
Î For step-down therapy after the patient has responded to initial
treatment, fluconazole, 400-800 mg (6-12 mg/kg) daily, is
recommended (S/L).
Î Therapy should continue until all signs and symptoms, cerebrospinal
fluid and radiological abnormalities have resolved (S/L).
Î Infected CNS devices, including ventriculostomy drains, shunts,
stimulators, prosthetic reconstructive devices, and biopolymer wafers
that deliver chemotherapy, should be removed if possible (S/L).
Î For patients in whom a ventricular device cannot be removed, AmB
deoxycholate could be administered through the device into the
ventricle at a dosage ranging from 0.01 mg to 0.5 mg in 2 mL 5%
dextrose in water (W/L).
