Candidiasis Flashcards
asymptomatic candiduria in usually well diabetic patient. No planned urological procedure/neutropenia. How to manage?
no antifungal needed. removal of catheter should suffice.
Neutropenic pt with asymptomatic candiduria. how to manage?
If neutropenic/low birth weight, treat as for candidaemia.
Well patient about to undergo urological manipulation. found to have asymptomatic candiduria. How to treat?
Give PO fluconazole 400mg/kg daily few days before and after procedure.
Patient with symptomatic candida cystitis. Candida sp. fluconazole-sensitive. How to treat?
give po fluconazole 200mg OD for 2 weeks.
pt with symptomatic candida cystitis. grew C.krusei/ fluconazole-R C.glabrata. How to treat?
Ambisome 7 days
consider bladder irrigation with AmB 5mg/L daily for 5 days
pt with candida pyelonephritis. Candida sp. fluconazole-sensitive.
how to treat?
as per symptomatic candiduria.
fluconazole 200mg po daily for 2 weeks.
pt with candida pyelonephritis. grew C.krusei/ fluconazole-R C.glabrata. How to treat?
as per fluconazole-R symptomatic candiduria.
Ambisome 7 days
Candida urine infection with fungus ball. How to manage?
- Surgery
- Antifungal as per symptomatic cystitis/pyelonephritis
- if got nephrostomy tube, irrigate
How to manage candida vulvovaginitis
- moderate?
- severe acute?
moderate: po fluconazole 150mg stat
severe acute: po fluconazole 150mg stat every 72 hours, for 3 doses
candida esophagitis. How to manage?
PO fluconazole 400mg od for 2-3 weeks
How to manage esophageal candida refractory to fluconazole?
give oral and iv option.
oral: itraconazole solution 200mg od or voriconazole 200mg bd
IV: echinocandin/ambisome
duration 2-3 weeks as per fluconazole-sensitive eosophageal candida
How to manage oropharyngeal candidiasis?
mild disease-
moderate-severe disease -
refractory disease -
chronic recurrent -
mild - topical nystatin/clotrimazole troche 7-14 days
moderate-severe disease - fluconazole 200mg OD 7-14 days
refractory disease - itraconazole/voriconazole/posaconazole/amB
chronic recurrent - fluconazole 100mg 3x a week (note inc to fluconazole 200mg 3x a week if esophageal)
How to manage chronic recurrent esophageal candidiasis?
fluconazole 200mg 3x a week
How to manage native valve candida endocarditis?
How long to treat?
what if fluconazole resistant?
initially, iv echinocandin/amB
step down to fluconazole when candidaemia cleared, pt improve and sensitive
valve surgery
continue treatment for at least 6 weeks post valve surgery
If fluconazole resistant, PO voriconazole/posaconazole.
Pt with native valve candida endocarditis. Can’t do valve surgery. How to manage?
what if fluconazole resistant?
initially, echinocandin/amB
step down to Po fluconazole when candidaemia cleared, pt well and sensitive
lifelong fluconazole 400mg OD
fluconazole resistant = Po voriconazole/posaconazole
pt with prosthetic valve candida endocarditis. How to manage?
Same as native valve endocarditis
+ replace valve
+ chronic suppression with fluconazole 400mg daily
(if fluconazole-resistant, give posaconazole/voriconazole)
patient with candida thrombophlebitis. how to manage?
As per candidaemia + catheter removal +I&D/resection of vein
resolution of thrombus can be considered as evidence to discontinue therapy if clinical and cultures allow.
How to treat intra-abdominal candidiasis?
same as candidaemia
+ surgery to remove collections
Implantable cardiac device - device candida infection. How to manage?
as per candida endocarditis - remove device, give AmB+-flucytosine/or echinocandin initially,
then step down to fluconazole when candidaemia cleared,
continue till at least 6 weeks post device removal.
if can’t remove device, then lifelong suppression with fluconazole 400mg daily.
implantable cardiac device - pocket infection only. How to manage?
remove device, then 4 weeks antifungal treatment.
implantable cardiac device - lead infection only. how to manage?
remove device, and 6 weeks antifungal treatment
candida osteomyelitis. How to manage?
give fluconazole 400mg od 6-12 months,
or echinocandin at least 2 weeks then fluconazole 6-12months
Native joint septic candida arthritis. How to manage?
surgical wash-out
fluconazole 400mg od for 6 weeks
OR
iv echinocandin first 2 weeks then fluconazole 4 weeks
candida endophthalmitis without vitritis. No macular involvement. How to manage?
if susceptible, iv fluconazole/voriconazole for min 4-6wks, depending on lesion improvement.
if resistant, iv AmB
