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7 Î For prosthetic valve endocarditis, the same antifungal regimens suggested for native valve endocarditis are recommended (S/L). Chronic suppressive antifungal therapy with fluconazole, 400-800 mg (6-12 mg/kg) daily, is recommended to prevent recurrence (S/L). Candida Infection of Implantable Cardiac Devices Î For pacemaker and implantable cardiac defibrillator infections, the entire device should be removed (S/M). Î Antifungal therapy is the same as that recommended for native valve endocarditis (S/L). Î For infections limited to generator pockets, 4 weeks of antifungal therapy after removal of the device is recommended (S/L). Î For infections involving the wires, ≥6 weeks of antifungal therapy after wire removal is recommended (S/L). Î For ventricular assist devices that cannot be removed, the antifungal regimen is the same as that recommended for native valve endocarditis (S/L). Chronic suppressive therapy with fluconazole if the isolate is susceptible, for as long as the device remains in place, is recommended (S/L). Candida Suppurative Thrombophlebitis Î Catheter removal and incision and drainage or resection of the vein, if feasible, is recommended (S/L). Î Lipid formulation AmB, 3-5 mg/kg daily, OR fluconazole, 400-800 mg (6-12 mg/kg) daily, OR an echinocandin (caspofungin, 150 mg daily, micafungin, 150 mg daily, or anidulafungin, 200 mg daily) for ≥2 weeks after candidemia (if present) has cleared is recommended (S/L). Î Step-down therapy to fluconazole, 400-800 mg (6-12 mg/kg) daily, should be considered for patients who have initially responded to AmB or an echinocandin, are clinically stable, and have a fluconazole- susceptible isolate (S/L). Î Resolution of the thrombus can be used as evidence to discontinue antifungal therapy if clinical and culture data are supportive (S/L). XI. Candida Osteoarticular Infections Candida Osteomyelitis Î Fluconazole, 400 mg (6 mg/kg) daily, for 6-12 months 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 6-12 months is recommended (S/L).

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