6
Management
VIII. Intra-Abdominal Candidiasis
Î Empirical antifungal therapy should be considered for patients
with clinical evidence of intra-abdominal infection and significant
risk factors for candidiasis, including recent abdominal surgery,
anastomotic leaks, or necrotizing pancreatitis (S/M).
Î Treatment of intra-abdominal candidiasis should include source
control, with appropriate drainage and/or debridement (S/M).
Î The choice of antifungal therapy is the same as for the treatment of
candidemia or empirical therapy for non-neutropenic patients in the
ICU (See Sections I and V) (S/M).
Î The duration of therapy should be determined by adequacy of source
control and clinical response (S/L).
IX. Candida Species in the Respiratory Tract
Î Growth of Candida from respiratory secretions usually indicates
colonization and rarely requires treatment with antifungal therapy
(S/M).
X. Candida Intravascular Infections, Including Endocarditis
and Infections of Implantable Cardiac Devices
Candida Endocarditis
Î For native valve endocarditis, lipid formulation AmB, 3-5 mg/kg daily,
with or without flucytosine, 25 mg/kg 4 times daily, OR high-dose
echinocandin (caspofungin, 150 mg daily, micafungin, 150 mg daily, or
anidulafungin, 200 mg daily) is recommended for initial therapy (S/L).
Î Step-down therapy to fluconazole, 400-800 mg (6-12 mg/kg) daily,
is recommended for patients who have susceptible Candida isolates,
have demonstrated clinical stability, and have cleared Candida from
the bloodstream (S/L).
Î Oral voriconazole, 200-300 mg (3-4 mg/kg) twice daily, or
posaconazole tablets, 300 mg daily, can be used as step down
therapy for isolates that are susceptible to those agents but not
susceptible to fluconazole (W/VL).
Î Valve replacement is recommended. Treatment should continue for
≥6 weeks after surgery and for a longer duration in patients with
perivalvular abscesses and other complications (S/L).
Î For patients who cannot undergo valve replacement, long-term
suppression with fluconazole, 400-800 mg (6-12 mg/kg) daily, if the
isolate is susceptible, is recommended (S/L).
