Treatment of chronic disseminated candidiasis (hepatosplenic candidiasis) in adults

Therapy

Initial therapy

Step-down therapy

Comments

A lipid formulation of amphotericin B 3 to 5 mg/kg IV daily OR an echinocandin (caspofungin 70 mg IV loading dose, then 50 mg IV daily; micafungin 100 mg IV daily; anidulafungin 200 mg IV loading dose, then 100 mg IV daily) for several weeks.

For most patients, initial therapy should be followed by step-down therapy with oral fluconazole (400 mg [6 mg/kg] daily).

For patients who have been shown to have a fluconazole-resistant isolate, such as patients who had a preceding candidemia with C. glabrata or C. krusei, we give step-down therapy with voriconazole or posaconazole. However, there is minimal experience using these agents for this form of candidiasis, and they should only be used if the organism has been shown to be susceptible.

Step-down therapy should continue until lesions have resolved on imaging (eg, contrast-enhanced computed tomography), which usually takes months, and should continue through periods of immunosuppression (eg, chemotherapy and hematopoietic cell transplantation).

The doses above are intended for patients with normal organ function. The fluconazole dose requires adjustment in the setting of renal insufficiency; the caspofungin dose requires adjustment in the setting of moderate or severe hepatic insufficiency. Refer to the Lexicomp monographs included within UpToDate for additional information including specific dose adjustment recommendations.

IV: intravenously.

Data from: Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.

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خرید پکیج

Treatment of chronic disseminated candidiasis (hepatosplenic candidiasis) in adults