|
|
| Line 7: |
Line 7: |
|
| |
|
| ==Medical Therapy== | | ==Medical Therapy== |
| ===Acute Pharmacotherapy===
| | According to, 2016 Update by the Infectious Diseases Society of America medical therapy for Candida vulvovaginitis includes<ref name="PappasKauffman2015">{{cite journal|last1=Pappas|first1=Peter G.|last2=Kauffman|first2=Carol A.|last3=Andes|first3=David R.|last4=Clancy|first4=Cornelius J.|last5=Marr|first5=Kieren A.|last6=Ostrosky-Zeichner|first6=Luis|last7=Reboli|first7=Annette C.|last8=Schuster|first8=Mindy G.|last9=Vazquez|first9=Jose A.|last10=Walsh|first10=Thomas J.|last11=Zaoutis|first11=Theoklis E.|last12=Sobel|first12=Jack D.|title=Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|year=2015|pages=civ933|issn=1058-4838|doi=10.1093/cid/civ933}}</ref>: |
| In clinical settings, candidiasis is commonly treated with antimycotics - the [[antifungal drug]]s commonly used to treat candidiasis are topical [[clotrimazole]], topical [[nystatin]], [[fluconazole]], and topical [[ketoconazole]]. In severe infections (generally in hospitalized patients), [[amphotericin B]], [[caspofungin]], or [[voriconazole]] may be used. Local treatment may include vaginal [[suppository|suppositories]] or medicated [[douche]]s. [[Gentian violet]] can be used for breastfeeding thrush, but pediatrician recommends using it sparingly, since in large quantities it can cause mouth and throat ulcerations in nursing babies, and has been linked to mouth cancer in humans and to cancer in the digestive tract of other animals. <ref>[http://extoxnet.orst.edu/newsletters/n115_91.htm extoxnet.orst.edu]</ref>
| | *Uncomplicated Candida Vulvovaginits: |
| | | **1st line :Any topical [[Antifungals|antifungal]] agents can be used and all of them have equal efficacy |
| ===Dietary Therapy===
| | **Alternative : Single 150mg dose of oral [[fluconazole]] is recommended |
| One of the most potent nondrug or natural yeast-fighting substances is caprylic acid, a medium-chain fatty acid derived from coconut oil. Caprylic acid in capsule form is commonly sold as a dietary supplement in health food stores. It is very effective against Candida and other forms of fungi. It is even effective mixed with a little coconut oil or vitamin E oil as a topical application for fungal skin infections. Some cases of fungal infections that have lasted for months clear up in a matter of days using caprylic acid and a little coconut oil. It works just as effectively inside the body, killing fungi without the least bit of harm.
| | *Severe acute Candida vulvovaginitis: |
| | | **1st line: Oral [[fluconazole]] 150mg, given every 72 hours for a total of 2 or 3 doses |
| Polynesian women who eat their traditional coconut-based diet rarely, if ever, get yeast infections. Only in more temperate climates where processed vegetable oils are the main source of dietary fat are yeast infections, skin fungus, acne, and other skin infections big problems. Lauric acid, found in coconut oil, kills lipid-coated bacteria but does not appear to harm the friendly intestinal bacteria. Medium-Chain Fatty Acids (MCFA)s also have antifungal properties, so not only will they kill disease-causing bacteria and leave good bacteria alone but also they will kill Candida and other fungi in the intestinal tract, further supporting a healthy intestinal environment. Eating coconut oil on a regular basis, as the Polynesians do, helps to keep Candida and other harmful microorganisms at bay.
| | *Candida glabrata: When unresponsive to oral [[azoles]] |
| | | **1st line: Topical intravaginal [[boric acid]] administered in a gelatin capsule, 600mg daily for 14 days |
| Some home remedies for candidiasis include the consumption or direct application of [[Yoghurt|yogurt]] (which contains [[lactobacillus]]), [[probiotics]], [[acidophilus]] tablets or salves, Pau d'arco tea, and even lightly crushed cloves of [[garlic]], which yield [[allicin]], an antifungal agent. [[Boric acid]] has also been used to treat yeast infections (by inserting gelcaps filled with boric acid powder into the vagina at bedtime for three to four consecutive nights). Eating a diet consisting primarily of green, fresh, raw vegetables also may give relief. Other alternative treatments consist in consuming a fermented beverage called [[Kefir]].
| | **2nd line: [[Nystatin]] intravaginal suppositories, 100,000 units daily for 14 days |
| | | **3rd line: Topical 17% [[flucytosine]] cream alone or in combination with [[amphotericin B]] cream daily for 14 days |
| While home remedies may offer relief in minor cases of infection (although a peer-reviewed study in Australia found yogurt ineffective as treatment for ''Candida albicans''), seeking medical attention may be necessary, especially if the extent of the infection cannot be judged accurately by the patient. For instance, oral thrush is visible only at the upper digestive tract, but it may be that the lower digestive tract is likewise colonized by ''Candida'' species.
| | *Recurring vulvovaginal candidiasis: |
| | | **1st line: 10 to 14 days of induction therapy with a topical agent or oral [[fluconazole]], followed by [[fluconazole]], 150mg weekly for 6 months |
| Treating candidiasis solely with medication may not give desired results, and other underlying causes require consideration. As an example, oral candidiasis is often linked to the use of inhaled [[corticosteroids]] in [[asthma medication]]. Patients on long-term inhaled corticosteroids should rinse their mouths after each dose of steroids to counteract this effect. Oral candidiasis can also be the sign of a more serious condition, such as [[HIV]] infection, or other immunodeficiency diseases. Following the health tips at [[vulvovaginal health]] can help prevent vaginal candidiasis.
| | ====Candida Vulvovaginitis in HIV positive women==== |
| | | *Treatment of symptomatic Candida vulvovaginitis in [[Human Immunodeficiency Virus (HIV)|HIV]]-positive women is similar to HIV-negative individuals. |
| Babies with diaper rash should have their diaper areas kept clean, dry, and exposed to air as much as possible. [[Sugar]]s assist the overgrowth of yeast, possibly explaining the increased prevalence of yeast infections in patients with [[diabetes mellitus]], as noted above. As many ''Candida spp.'' reside in the digestive tract, dietary changes may be effective for preventing or during a ''Candida'' infection. Due to its requirement for readily fermentable carbon sources, such as mono- or dimeric sugars (e.g., [[sucrose]], [[glucose]], [[lactose]]) and starch, avoiding foods that contain these nutrients in high abundance may help to prevent excessive ''Candida'' growth. [[Breast milk]] is a suitable growth substrate for yeasts, and both nursing mother and baby need to be treated (even if both are not symptomatic) to prevent thrush from being passed between mother and child. <ref>[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=123132 PubMed Central Article]</ref>
| |
| | |
| ===Candiduria===
| |
| | |
| ====Asymptomatic Candiduria====
| |
| It is not recommended to treat asymptomatic candidiuria in otherwise healthy or predisposed patients because mostly it's self limited and resolves spontaneously,and to avoid recurrence and treatment complications. However, removal of the urine catheter is advised when possible. For patients with a risk of disseminated candidiasis or undergoing invasive urological procedure, antifungal therapy is required.
| |
| | |
| ===Antimicrobial Regimen===
| |
| *Candidiasis
| |
| :*'''1. Candidemia'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*'''1.1. Nonneutropenic adults'''
| |
| :::*Preferred regimen (1): [[Fluconazole]] 800 mg (12 mg/kg) loading dose, {{then}} 400 mg (6 mg/kg) daily
| |
| :::*Preferred regimen (2): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily
| |
| :::*Preferred regimen (3): [[Micafungin]] 100 mg daily
| |
| :::*Preferred regimen (4): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily
| |
| :::*Alternative regimen (1): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily
| |
| :::*Alternative regimen (2): Amphotericin B deoxycholate(AmB-d) 0.5–1.0 mg/kg daily
| |
| :::*Alternative regimen (3): [[Voriconazole]] 400 mg (6 mg/kg) PO/IV bid for 2 doses, {{then}} 200 mg (3 mg/kg) bid
| |
| :::*Note (1): Echinocandin includes Anidulafungin, Micafungin and Caspofungin.
| |
| :::*Note (2): Choose an echinocandin for moderately severe to severe illness and for patients with recent azole exposure.
| |
| :::*Note (3): Treat for 14 days after first negative blood culture result and resolution of signs and symptoms associated with candidemia.
| |
| :::*Note (4): Ophthalmological examination recommended for all patients.
| |
| | |
| ::*'''1.2. Neutropenic patients'''
| |
| :::*Preferred regimen (1): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily
| |
| :::*Preferred regimen (2): [[Micafungin]] 100 mg daily
| |
| :::*Preferred regimen (3): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily
| |
| :::*Preferred regimen (4): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily
| |
| :::*Alternative regimen (1): [[Fluconazole]] 800 mg (12 mg/kg) loading dose, {{then}} 400 mg (6 mg/kg) daily
| |
| :::*Alternative regimen (2): [[Voriconazole]] 400 mg (6 mg/kg) bid for 2 doses, {{then}} 200 mg (3 mg/kg) bid
| |
| :::*Note: Fluconazole is recommended for patients without recent azole exposure and who are not critically ill.
| |
| | |
| :*'''2. Suspected candidiasis treated with empiric antifungal therapy'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*'''2.1. Nonneutropenic patients'''
| |
| :::*Preferred regimen (1): [[Fluconazole]] 800 mg (12 mg/kg) loading dose, {{then}} 400 mg (6 mg/kg) daily
| |
| :::*Preferred regimen (2): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily
| |
| :::*Preferred regimen (3): [[Micafungin]] 100 mg daily
| |
| :::*Preferred regimen (4): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily
| |
| :::*Alternative regimen (1): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily
| |
| :::*Alternative regimen (2): Amphotericin B deoxycholate(AmB-d) 0.5–1.0 mg/kg daily
| |
| :::*Note (1): Duration of therapy is uncertain, but should be discontinued if cultures and/or serodiagnostic tests have negative results.
| |
| :::*Note (2): Echinocandin includes Anidulafungin, Micafungin and Caspofungin.
| |
| :::*Note (3): Echinocandin is preferred for patients with recent azole exposure, patients with moderately severe to severe illness, or patients who are at high risk of infection due to C. glabrata or C. krusei.
| |
| :::*Note (4): Empirical antifungal therapy should be considered in critically ill patients with risk factors for invasive candidiasis and no other known cause of fever and should be based on clinical assessment of risk factors, serologic markers for invasive candidiasis, and/or culture data from nonsterile sites
| |
| | |
| ::*'''2.2. Neutropenic patients'''
| |
| :::*Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily
| |
| :::*Preferred regimen (2): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily
| |
| :::*Preferred regimen (3): [[Voriconazole]] 400 mg (6 mg/kg) bid for 2 doses, {{then}} 200 mg (3 mg/kg) bid
| |
| :::*Alternative regimen (1): [[Fluconazole]] 800 mg (12 mg/kg) loading dose, {{then}} 400 mg (6 mg/kg) daily
| |
| :::*Alternative regimen (2): [[Itraconazole]] 200 mg (3 mg/ kg) bid
| |
| :::*Note (1): In most neutropenic patients, it is appropriate to initiate empiric antifungal therapy after 4 days of persistent fever despite antibiotics.
| |
| :::*Note (2): Do not use an azole in patients with prior azole prophylaxis.
| |
| | |
| :*'''3. Urinary tract infection'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*'''3.1. Asymptomatic cystitis'''
| |
| :::*Preferred regimen: Therapy not usually indicated, unless patients are at high risk (e.g., neonates and neutropenic adults) or undergoing urologic procedures.
| |
| :::*Note (1): Elimination of predisposing factors recommended
| |
| :::*Note (2): For high-risk patients, treat as for disseminated candidiasis
| |
| :::*Note (3): For patients undergoing urologic procedures, fluconazole, 200–400 mg (3–6 mg/kg) daily or Amphotericin B deoxycholate(AmB-d) 0.3–0.6 mg/kg daily for several days before and after the procedure.
| |
| | |
| ::*'''3.2. Symptomatic cystitis'''
| |
| :::*Preferred regimen: [[Fluconazole]] 200 mg (3 mg/kg) daily for 2 weeks
| |
| :::*Alternative regimen (1): Amphotericin B deoxycholate(AmB-d) 0.3–0.6 mg/kg for 1–7 days
| |
| :::*Alternative regimen (2): [[Flucytosine]] 25 mg/kg qid for 7–10 days
| |
| :::*Note: Amphotericin B deoxycholate(AmB-d) bladder irrigation is recommended only for patients with refractory fluconazole-resistant organisms (e.g., Candida krusei and Candida glabrata).
| |
| | |
| ::*'''3.3 Pyelonephritis'''
| |
| :::*Preferred regimen (1): [[Fluconazole]] 200–400 mg (3–6 mg/kg) daily for 2 weeks
| |
| :::*Alternative regimen (1): Amphotericin B deoxycholate(AmB-d) 0.5–0.7 mg/kg daily {{withorwithout}} [[Flucytosine]] (5-FC) 25 mg/kg qid
| |
| :::*Alternative regimen (2): [[Flucytosine]] (5-FC) 25 mg/kg qid for 2 weeks
| |
| :::*Note: For patients with pyelonephritis and suspected disseminated candidiasis, treat as for candidemia.
| |
| | |
| :*'''4. Urinary fungus balls'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*Preferred regimen (1): Surgical removal strongly recommended
| |
| ::*Preferred regimen (2): [[Fluconazole]] 200–400 mg (3–6 mg/kg) daily
| |
| ::*Preferred regimen (3): Amphotericin B deoxycholate(AmB-d) 0.5–0.7 mg/kg daily {{withorwithout}} [[Flucytosine]] (5-FC) 25 mg/kg qid
| |
| ::*Note (1): Local irrigation with Amphotericin B deoxycholate(AmB-d) may be a useful adjunct to systemic antifungal therapy.
| |
| ::*Note (2): Treatment duration should be until symptoms have resolved and urine cultures no longer yield Candida species.
| |
| | |
| :*'''5. Vulvovaginal candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*Preferred regimen (1): [[Butoconazole]] 2% cream 5 g intravaginally for 3 days
| |
| ::*Preferred regimen (2): [[Butoconazole]] 2% cream 5 g (butoconazole1-sustained release), single intravaginal application
| |
| ::*Preferred regimen (3): [[Clotrimazole]] 1% cream 5 g intravaginally for 7–14 days
| |
| ::*Preferred regimen (4): [[Clotrimazole]] 100-mg vaginal tablet for 7 days
| |
| ::*Preferred regimen (5): [[Clotrimazole]] 100-mg vaginal tablet, 2 tablets for 3 days
| |
| ::*Preferred regimen (6): [[Miconazole]] 2% cream 5 g intravaginally for 7 days
| |
| ::*Preferred regimen (7): [[Miconazole]] 100-mg vaginal suppository, 1 suppository for 7 days
| |
| ::*Preferred regimen (8): [[Miconazole]] 200-mg vaginal suppository, 1 suppository for 3 days
| |
| ::*Preferred regimen (9): [[Miconazole]] 1200-mg vaginal suppository, 1 suppository for 1 day
| |
| ::*Preferred regimen (10): [[Nystatin]] 100,000-unit vaginal tablet, 1 tablet for 14 days
| |
| ::*Preferred regimen (11): [[Tioconazole]] 6.5% ointment 5 g intravaginally in a single application
| |
| ::*Preferred regimen (12): [[Terconazole]] 0.4% cream 5 g intravaginally for 7 days
| |
| ::*Preferred regimen (13): [[Terconazole]] 0.4% cream 5 g intravaginally for 3 days
| |
| ::*Preferred regimen (14): [[Terconazole]] 80-mg vaginal suppository, 1 suppository for 3 days
| |
| ::*Preferred regimen (15): [[Fluconazole]] 150 mg single dose for uncomplicated vaginitis
| |
| ::*Note: For recurring Candida Vulvovaginal candidiasis (VVC), 10–14 days of induction therapy with a topical or oral azole, followed by fluconazole at a dosage of 150 mg once per week for 6 months, is recommended
| |
| | |
| :*'''6. Chronic disseminated candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*Preferred regimen (1): [[Fluconazole]] 400 mg (6 mg/kg) daily for stable patients
| |
| ::*Preferred regimen (2): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily for severely ill patients
| |
| ::*Preferred regimen (3): Amphotericin B deoxycholate(AmB-d) 0.5–0.7 mg/kg daily for severely ill patients
| |
| ::*Alternative regimen (1): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily, followed by oral [[Fluconazole]] when clinically appropriate
| |
| ::*Alternative regimen (2): [[Micafungin]] 100 mg daily, followed by oral [[Fluconazole]] when clinically appropriate
| |
| ::*Alternative regimen (3): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily, followed by oral [[Fluconazole]] when clinically appropriate
| |
| ::*Note (1): Transition from Lipid formulation of amphotericin B(LFAmB) or Amphotericin B deoxycholate(AmB-d) to fluconazole is favored after several weeks in stable patients.
| |
| ::*Note (2): Duration of therapy is until lesions have resolved (usually months) and should continue through periods of immunosuppression (e.g., chemotherapy and transplantation).
| |
| ::*Note (3): Therapy should be continued for weeks to months, until calcification occurs or lesions resolve.
| |
| | |
| :*'''7. Candida osteoarticular infection'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*'''7.1. Osteomyelitis'''
| |
| :::*Preferred regimen (1): [[Fluconazole]] 400 mg (6 mg/kg) daily for 6–12 months
| |
| :::*Preferred regimen (2): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily for at least 2 weeks, then [[Fluconazole]] 400 mg daily for 6–12 months
| |
| :::*Alternative regimen (1): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily for 6–12 months
| |
| :::*Alternative regimen (2): [[Micafungin]] 100 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily for 6–12 months
| |
| :::*Alternative regimen (3): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily for 6–12 months
| |
| :::*Alternative regimen (4): Amphotericin B deoxycholate(AmB-d) 0.5–1.0 mg/kg daily followed by [[Fluconazole]] at a dosage of 400 mg daily for 6–12 months
| |
| :::*Note (1): Duration of therapy usually is prolonged (6–12 months)
| |
| :::*Note (2): Surgical debridement is frequently necessary
| |
| | |
| ::*'''7.2. Septic arthritis'''
| |
| :::*Preferred regimen (1): [[Fluconazole]] 400 mg (6 mg/kg) for at least 6 weeks
| |
| :::*Preferred regimen (2): Lipid formulation of amphotericin B (LFAmB) 3–5 mg/kg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily
| |
| :::*Alternative regimen (1): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily
| |
| :::*Alternative regimen (2): [[Micafungin]] 100 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily
| |
| :::*Alternative regimen (3): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily
| |
| :::*Note (1): Duration of therapy usually is for at least 6 weeks, but few data are available.
| |
| :::*Note (2): Surgical debridement is recommended for all cases.
| |
| :::*Note (3): For infected prosthetic joints, removal is recommended for most cases.
| |
| | |
| :*'''8. CNS candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily {{withorwithout}} [[Flucytosine]] at a dosage of 25 mg/kg qid for several weeks followed by [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
| |
| ::*Alternative regimen (1): [[Fluconazole]] 400–800 mg (6–12 mg/ kg) daily for patients unable to tolerate Lipid formulation of amphotericin B (LFAmB)
| |
| ::*Note (1): Treat until all signs and symptoms, CSF abnormalities, and radiologic abnormalities have resolved.
| |
| ::*Note (2): Removal of intraventricular devices is recommended.
| |
| | |
| :*'''9. Candida endophthalmitis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*Preferred regimen (1): Amphotericin B deoxycholate(AmB-d) 0.7–1 mg/kg {{and}} [[Flucytosine]] 25 mg/ kg qid
| |
| ::*Preferred regimen (2): [[Fluconazole]] 400–800 mg daily (loading dose of 12 mg/kg then 6–12 mg/kg daily) is an acceptable alternative for less severe endophthalmitis
| |
| ::*Alternative regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily
| |
| ::*Alternative regimen (2): [[Voriconazole]] 6 mg/kg q12h for 2 doses, then 3–4 mg/kg q12h
| |
| ::*Alternative regimen (3): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily
| |
| ::*Alternative regimen (4): [[Micafungin]] 100 mg daily
| |
| ::*Alternative regimen (5): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily
| |
| ::*Note (1): Alternative therapy is recommended for patients intolerant of or experiencing failure of Amphotericin B and Flucytosine therapy
| |
| ::*Note (2): Duration of therapy is at least 4–6 weeks as determined by repeated examinations to verify resolution.
| |
| ::*Note (3): Diagnostic vitreal aspiration should be done if etiology unknown.
| |
| ::*Note (4): Fluconazole at a dosage of 400–800 mg daily (loading dose of 12 mg/kg then 6–12 mg/kg daily) is an acceptable alternative for less severe endophthalmitis
| |
| ::*Note (5): Surgical intervention for patients with severe endophthalmitis or vitreitis
| |
| | |
| :*'''10. Candida infection of the cardiovascular system'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*'''10.1. Endocarditis'''
| |
| :::*Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily {{withorwithout}} [[Flucytosine]] at a dosage of 25 mg/kg qid
| |
| :::*Preferred regimen (2): Amphotericin B deoxycholate AmB-d 0.6–1 mg/kg daily {{withorwithout}} [[Flucytosine]] 25 mg/kg qid
| |
| :::*Preferred regimen (3): [[Caspofungin]] 50–150 mg daily
| |
| :::*Preferred regimen (4): [[Micafungin]] 100–150 mg daily
| |
| :::*Preferred regimen (5): [[Anidulafungin]] 100–200 mg daily
| |
| :::*Alternative regimen (1): Step-down therapy to [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily for susceptible organism in stable patient with negative blood culture results
| |
| :::*Note (1): Valve replacement is strongly recommended.
| |
| :::*Note (2): For those who are unable to undergo surgical removal of the valve, chronic suppression with fluconazole 400–800 mg (6–12 mg/kg) daily is recommended.
| |
| :::*Note (3): Lifelong suppressive therapy for prosthetic valve endocarditis if valve cannot be replaced is recommended.
| |
| | |
| ::*'''10.2. Pericarditis or myocarditis'''
| |
| :::*Preferred regimen (1): Lipid formulation of amphotericin B (LFAmB) at a dosage of 3–5 mg/kg daily
| |
| :::*Preferred regimen (2): [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
| |
| :::*Preferred regimen (3): [[Caspofungin]] 50–150 mg daily
| |
| :::*Preferred regimen (4): [[Micafungin]] 100–150 mg daily
| |
| :::*Preferred regimen (5): [[Anidulafungin]] 100–200 mg daily
| |
| :::*Alternative regimen (1): After stable, step-down therapy to [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
| |
| :::*Note(1): Therapy is often for several months, but few data are available
| |
| :::*Note(2): A pericardial window or pericardiectomy is recommended.
| |
| | |
| ::*'''10.3. Suppurative thrombophlebitis'''
| |
| :::*Preferred regimen (1): Lipid formulation of amphotericin B (LFAmB) at a dosage of 3–5 mg/kg daily
| |
| :::*Preferred regimen (2): [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
| |
| :::*Preferred regimen (3): [[Caspofungin]] 50–150 mg daily
| |
| :::*Preferred regimen (4): [[Micafungin]] 100–150 mg daily
| |
| :::*Preferred regimen (5): [[Anidulafungin]] 100–200 mg daily
| |
| :::*Alternative regimen (1): After stable, step-down therapy to [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
| |
| :::*Note(1): Surgical incision and drainage or resection of the vein is recommended if feasible.
| |
| :::*Note(2): Treat for at least 2 weeks after candidemia has cleared.
| |
| | |
| ::*'''10.4. Infected pacemaker, ICD, or VAD'''
| |
| :::*Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily {{withorwithout}} [[Flucytosine]] at a dosage of 25 mg/kg qid
| |
| :::*Preferred regimen (2): Amphotericin B deoxycholate (AmB-d) 0.6–1 mg/kg daily {{withorwithout}} [[Flucytosine]] 25 mg/kg qid
| |
| :::*Preferred regimen (3): [[Caspofungin]] 50–150 mg daily
| |
| :::*Preferred regimen (4): [[Micafungin]] 100–150 mg daily
| |
| :::*Preferred regimen (5): [[Anidulafungin]] 100–200 mg daily
| |
| :::*Alternative regimen (1): Step-down therapy to [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily for susceptible organism in stable patient with negative blood culture results
| |
| :::*Note(1): Removal of pacemakers and ICDs strongly recommended.
| |
| :::*Note(2): Treat for 4–6 weeks after the device removed.
| |
| :::*Note(3): For VAD that cannot be removed, chronic suppressive therapy with fluconazole is recommended.
| |
| | |
| :*'''11. Neonatal candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*Preferred regimen (1): Amphotericin B deoxycholate (AmB-d) 1 mg/kg daily for 3 weeks
| |
| ::*Preferred regimen (2): [[Fluconazole]] 12 mg/kg daily for 3 weeks
| |
| ::*Alternative regimen (1): Lipid formulation of amphotericin B (LFAmB) 3–5 mg/kg daily for 3 weeks
| |
| ::*Note (1): A lumbar puncture and dilated retinal examination should be performed on all neonates with suspected invasive candidiasis.
| |
| ::*Note (2): Intravascular catheter removal is strongly recommended.
| |
| ::*Note (3): Duration of therapy is at least 3 weeks.
| |
| ::*Note (4): Lipid formulation of amphotericin B (LFAmB) used only if there is no renal involvement.
| |
| ::*Note (5): Echinocandins should be used with caution when other agents cannot be used.
| |
| | |
| :*'''12. Candida isolated from respiratory secretions'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::*Preferred regimen (1): Therapy not recommended
| |
| ::*Note (1): Candida lower respiratory tract infection is rare and requires histopathologic evidence to confirm a diagnosis.
| |
| | |
| :*'''13. Nongenital mucocutaneous candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref>
| |
| ::* '''13.1. Oropharyngeal'''
| |
| :::*Preferred regimen (1): [[Clotrimazole]] troches 10 mg 5 times daily
| |
| :::*Preferred regimen (2): [[Nystatin]] suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL qid {{or}} 1–2 [[Nystatin]] pastilles (200,000 U each) administered qid for 7–14 days
| |
| :::*Preferred regimen (3): [[Fluconazole]] 100–200 mg PO (3 mg/kg) daily for 7–14 days
| |
| :::*Alternative regimen (1): [[Itraconazole]] solution 200 mg daily
| |
| :::*Alternative regimen (2): [[Posaconazole]] suspension at a dosage of 400 mg twice daily for 3 days, {{then}} 400 mg daily for up to 28 days
| |
| :::*Alternative regimen (3): [[Voriconazole]] 200 mg bid
| |
| :::*Alternative regimen (4): Amphotericin B deoxycholate (AmB-d) 1-mL oral suspension administered at a dosage of 100 mg/mL qid
| |
| :::*Alternative regimen (5): [[Caspofungin]] 70 mg IV loading dose, {{then}} 50 mg daily
| |
| :::*Alternative regimen (6): [[Micafungin]] 100 mg IV daily
| |
| :::*Alternative regimen (7): [[Anidulafungin]] 200 mg IV loading dose, {{then}} 100 mg daily
| |
| :::*Alternative regimen (8): Amphotericin B deoxycholate (AmB-d) 0.3 mg/kg daily
| |
| :::*Note(1): [[Fluconazole]] is recommended for moderate-to-severe disease, and topical therapy with clotrimazole or nystatin is recommended for mild disease.
| |
| :::*Note(2): Treat uncomplicated disease for 7–14 days.
| |
| :::*Note(3): For refractory disease, itraconazole, voriconazole, posaconazole, or AmB suspension is recommended.
| |
| | |
| ::*'''13.2. Esophageal'''
| |
| :::*Preferred regimen (1): Fluconazole 200–400 mg (3–6 mg/kg) PO daily
| |
| :::*Preferred regimen (2): [[Caspofungin]] 70 mg IV loading dose, {{then}} 50 mg daily
| |
| :::*Preferred regimen (3): [[Micafungin]] 100 mg IV daily
| |
| :::*Preferred regimen (4): [[Anidulafungin]] 200 mg IV loading dose, {{then}} 100 mg daily
| |
| :::*Preferred regimen (4): AmB-d 0.3–0.7 mg/kg daily
| |
| :::*Alternative regimen (1): [[Itraconazole]] oral solution 200 mg daily
| |
| :::*Alternative regimen (2): [[Posaconazole]] 400 mg bid
| |
| :::*Alternative regimen (3): [[Voriconazole]] 200 mg bid
| |
| :::*Note(1): Oral fluconazole is preferred.
| |
| :::*Note(2): For patients unable to tolerate an oral agent, IV fluconazole, an echinocandin, or AmB-d is appropriate.
| |
| :::*Note(3): Treat for 14–21 days.
| |
| :::*Note(4): For patients with refractory disease, the alternative therapy as listed or AmB-d or an echinocandin is recommended.
| |
| | |
| ==References==
| |
| {{Reflist|2}}
| |
| | |
| | |
| | |
| | |
| {{WikiDoc Help Menu}}
| |
| {{WS}}
| |