Candidemia - Empiric Therapy, Follow Up and Duration of Therapy

Empiric Therapy

Please call Infectious Diseases for approval to initiate caspofungin.

OR

Empiric fluconazole should only be used in selected patients who are not critically ill and who are considered unlikely to have a fluconazole-resistant Candida species.

Follow Up

Testing for azole susceptibility is recommended for all bloodstream Candida isolates.

Transition from an echinocandin to fluconazole is recommended for patients who are clinically stable, have isolates that are susceptible to fluconazole and have negative repeat blood cultures following initiation of antifungal therapy.

For infection due to Candida glabrata, transition to higher-dose fluconazole (800mg daily) should be considered among patients with fluconazole-susceptible (dose-dependent) isolates.

Duration of Therapy

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.

Duration of therapy in the setting of metastatic foci should be determined in collaboration with

the Infectious Diseases consultation team.