S52(4) Oral and esophageal candida Flashcards
“cottage cheese” appearance
Yellowish white
Soft plaques overlying areas of erythema on the buccal mucosa, tongue, gums, and throat
Oropharyngeal Candidiasis (Thrush)
Diagnosed on appearance
Treatment of mild Oropharyngeal Candidiasis (Thrush)
- Clotrimazole troches 10mg 5 times daily x 7-10 days OR
- Miconazole mucoadhesive buccal 50mg tablet applied to the mucosal surface one daily x 7-10 days
can see:
Nystatin suspension 100,000 U/mL 4-6mL 4 times daily x 7-14 days OR
1-2 nystatin pastilles (200,000 U each) 4 times daily x 7-14 days
Treatment of moderate to severe Oropharyngeal Candidiasis (Thrush)
Fluconazole 100-200mg daily x 7-14 days
Esophageal Candidiasis Requires systemic antifungal therapy
Fluconazole 200-400mg (3-6mg/kg) PO daily x 14-21 days
Esophageal Candidiasis Requires systemic antifungal therapy if NOT able to take PO
Fluconazole 400mg (6mg/kg) IV daily Echinocandin but different doses Micafungin 150mg IV daily Caspofungin 70mg LD then 50mg IV daily Anidulafungin 200mg IV daily
Risk Factors for Invasive Fungal Infections (IFI)
General
Neutropenia (ANC < 500/mm3)
AIDS
Immunosuppressive therapy
Risk Factors for Invasive Fungal Infections (IFI)
Candida Specific
Exposure to broad spectrum antibiotics
Recent major surgery (especially abdominal surgery)
Parenteral nutrition
Central venous catheters
Candidemia (candida in the blood)
empiric therapy
micafungin
Candidemia (candida in the blood)
definitive therapy
alibicans
Fluconazole 12mg/kg load then 6 mg/kg daily
Voriconazole 6mg/kg twice daily x 2 doses then 3 mg/kg twice daily
For step down therapy resistant to fluconazole
Candidemia (candida in the blood) duration of therapy
2 weeks from first negative culture
Candida endocarditis empiric therapy
amphotericin B
Main therapy source control
prostetic vlve replacement
Intra-abdominal Candidiasis
Source control!!!
Empiric: Echinocandin
Micafungin 100mg daily
Caspofungin 70mg LD then 50mg daily
Andiulafungin 200mg LD then 100mg daily
Oropharyngeal Candidiasis
First Line Empiric
Mild: Clotrimazole or Miconazole
Mod-Severe: Fluc
Esophageal Candidiasis
First Line Empiric
Fluconazole
Candidemia
First Line Empiric
Echinocandin
Micafungin 100mg daily
Caspofungin 70mg LD then 50mg daily
Andiulafungin 200mg LD then 100mg daily