8
Management
Î Lipid formulation AmB, 3-5 mg/kg daily, for ≥2 weeks followed
by fluconazole, 400 mg (6 mg/kg) daily, for 6-12 months is a less
attractive alternative (W/L).
Î Surgical debridement is recommended in selected cases (S/L).
Candida Septic Arthritis
Î Fluconazole, 400 mg (6 mg/kg) daily, for 6 weeks OR an echinocandin
(caspofungin 50-70 mg daily, micafungin 100 mg daily, or
anidulafungin 100 mg daily) for 2 weeks followed by fluconazole,
400 mg (6 mg/kg) daily, for ≥4 weeks is recommended (S/L).
Î Lipid formulation AmB, 3-5 mg/kg daily, for 2 weeks, followed by
fluconazole, 400 mg (6 mg/kg) daily, for ≥4 weeks is a less attractive
alternative (W/L).
Î Surgical drainage is indicated in all cases of septic arthritis (S/M).
Î For septic arthritis involving a prosthetic device, device removal is
recommended (S/M).
Î If the prosthetic device cannot be removed, chronic suppression with
fluconazole, 400 mg (6 mg/kg) daily, if the isolate is susceptible, is
recommended (S/L).
XII. Candida Endophthalmitis
General Approach to Candida Endophthalmitis
Î All patients with candidemia should have a dilated retinal examination,
preferably performed by an ophthalmologist, within the first week of
therapy in non-neutropenic patients to establish if endophthalmitis is
present (S/L). For neutropenic patients it is recommended to delay the
examination until neutrophil recovery (S/L).
Î The extent of ocular infection (chorioretinitis with or without macular
involvement and with or without vitritis) should be determined by an
ophthalmologist (S/L).
Î Decisions regarding antifungal treatment and surgical intervention
should be made jointly by an ophthalmologist and an infectious
diseases physician (S/L).
Candida Chorioretinitis WITHOUT Vitritis
Î For fluconazole/voriconazole susceptible isolates, fluconazole, loading
dose, 800 mg (12 mg/kg), then 400-800 mg (6-12 mg/kg) daily OR
voriconazole, loading dose 400 mg (6 mg/kg) IV twice daily for 2 doses,
then 300 mg (4 mg/kg) IV or oral twice daily is recommended (S/L).
