Management
2
Î Follow-up blood cultures should be performed every day or every other
day to establish the time point at which candidemia has been cleared
(S/L).
Î Recommended duration of therapy for candidemia without obvious
metastatic complications is for 2 weeks after documented clearance
of Candida species from the bloodstream and resolution of symptoms
attributable to candidemia (S/M).
II. Central Venous Catheters (CVCs) in Non-Neutropenic
Patients with Candidemia
Î CVCs should be removed as early as possible in the course of
candidemia when the source is presumed to be the CVC and the
catheter can be removed safely. This decision should be individualized
for each patient (S/M).
III. Candidemia in Neutropenic Patients
Î An echinocandin (caspofungin, loading dose 70 mg, then 50 mg daily;
micafungin, 100 mg daily; anidulafungin, loading dose 200 mg, then
100 mg daily) is recommended as initial therapy (S/M).
Î Lipid formulation AmB, 3-5 mg/kg daily, is an effective but less
attractive alternative because of the potential for toxicity (S/M).
Î Fluconazole, 800 mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg)
daily, is an alternative for patients who are not critically ill and have
had no prior azole exposure (W/L).
Î Fluconazole, 400 mg (6 mg/kg) daily, can be used for step-down
therapy during persistent neutropenia in clinically stable patients who
have susceptible isolates and documented bloodstream clearance
(W/L).
Î Voriconazole, 400 mg (6 mg/kg) twice daily for 2 doses, then 200-
300 mg (3-4 mg/kg) twice daily, can be used in situations in which
additional mold coverage is desired (W/L). Voriconazole can also be
used as step-down therapy during neutropenia in clinically stable
patients who have had documented bloodstream clearance and
isolates that are susceptible to voriconazole (W/L).
Î For infections due to C. krusei, an echinocandin, lipid formulation
AmB, or voriconazole is recommended (S/L).
Î Recommended minimum duration of therapy for candidemia without
metastatic complications is 2 weeks after documented clearance of
Candida from the bloodstream, provided neutropenia and symptoms
attributable to candidemia have resolved (S/L).
