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).
