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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).

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