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Guideline source: Infectious Diseases Society of America
Literature search described? Yes
Evidence rating system used? Yes
Published source: Clinical Infectious Diseases, March 1, 2009
Available at: http://www.journals.uchicago.edu/doi/full/10.1086/596757
Since the Infectious Diseases Society of America (IDSA) published its clinical guideline on the management of candidiasis in 2004, several new antifungal agents have become available, and studies have provided new evidence on the treatment of candidemia; other forms of invasive candidiasis; and mucosal disease, including oropharyngeal and esophageal candidiasis. In light of these new findings, the IDSA has published updated recommendations. The most significant changes are discussed below, and the full recommendations (including dosing regimens) are summarized in Table 1.
Candidemia
nonneutropenic patients
Initial therapy for most nonneutropenic adults with candidemia should be fluconazole (Diflucan) or an echinocandin (e.g., caspofungin [Cancidas], anidulafungin [Eraxis], micafungin [Mycamine]). Echinocandins are preferred in patients with moderately severe to severe illness and in patients who have had recent azole exposure. Fluconazole is recommended for patients who are less critically ill and who have not been recently exposed to azoles. The same approach, with differences in dosing regimens, is advised for children.
An echinocandin is also preferred for patients infected with Candida glabrata; transitioning to fluconazole or voriconazole (Vfend) is not recommended without confirmation of isolate susceptibility. Patients who initially received fluconazole...