4
Management
Î Fluconazole, 800 mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg)
daily, is an acceptable alternative for patients who have had no recent
azole exposure and are not colonized with azole resistant Candida
species (S/M).
Î Lipid formulation AmB, 3-5 mg/kg daily, is an alternative if there is
intolerance to other antifungal agents (S/L).
Î Recommended duration of empirical therapy for suspected invasive
candidiasis in those patients who improve is 2 weeks, the same as for
treatment of documented candidemia (W/L).
Î For patients who have no clinical response to empirical antifungal
therapy at 4-5 days and who do not have subsequent evidence of
invasive candidiasis after the start of empirical therapy or have a
negative non-culture-based diagnostic assay with a high negative
predictive value, consideration should be given to stopping antifungal
therapy (S/L).
VI. Prophylaxis to Prevent Invasive Candidiasis in the ICU
Setting
Î Fluconazole, 800 mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg)
daily, could be used in high-risk patients in adult ICUs with a high rate
(>5%) of invasive candidiasis (W/M).
Î An alternative is to give an echinocandin (caspofungin, 70 mg loading
dose, then 50 mg daily; anidulafungin 200 mg loading dose and then
100 mg daily; or micafungin, 100 mg daily) (W/L).
Î Daily bathing of ICU patients with chlorhexidine, which has been
shown to decrease the incidence of bloodstream infections including
candidemia, could be considered (W/M).
VII. Neonatal Candidiasis, including Central Nervous System
Infection
Invasive Candidiasis and Candidemia
Î AmB deoxycholate, 1 mg/kg daily, is recommended for neonates with
disseminated candidiasis (S/M).
Î Fluconazole, 12 mg/kg IV or oral daily, is a reasonable alternative in
patients who have not been on fluconazole prophylaxis (S/M).
Î Lipid formulation AmB, 3-5 mg/kg daily, is an alternative, but should
be used with caution, particularly in the presence of urinary tract
involvement (W/L).
Î Echinocandins should be used with caution and generally limited
to salvage therapy or to situations in which resistance or toxicity
preclude the use of AmB deoxycholate or fluconazole (W/L).
