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Candidiasis
Aka: Candidiasis, Moniliasis, Urinary Tract Candidiasis, Candiduria- See Also
- Etiology
- Candida albicans
- Risk Factors
- Skin maceration
- Immunosuppressed patients
- Advanced Human Immunodeficiency Virus (AIDS)
- Hematologic Malignancy
- Antibiotic use
- Corticosteroid use
- Pregnancy
- Diabetes Mellitus
- Signs: Systemic involvement in immunocompromised patient
- Severe muscle tenderness
- Signs: Mucocutaneous Rash
- Signs: Specific Lesions
- Oral Thrush
- White Plaques firmly adhered to Oral Mucosa
- Cutaneous Candidiasis
- Red, macerated intertriginous areas
- Chronic mucocutaneous Candidiasis
- Circumscribed hyperkeratotic skin lesions
- Dystrophic Nails
- Partial Alopecia
- Oral and vaginal Thrush
- Endocrine organ hypofunction
- Gastrointestinal
- Distal esophagus ulcerations
- Hematogenous (Immunosuppressed)
- Oral Thrush
- Labs
- Abscess drainage shows candida mycelia
- Candida Serology titers elevated
- KOH Preparation
- Pseudohyphae
- Management: General
- Cutaneous
- Nystatin
- Ciclopirox
- Imidazole cream
- Oral Thrush
- Clotrimazole
- One troche dissolve in mouth x5 qd for 7-14 days
- Nystatin suspension
- Swish and swallow 4-6 times per day for 7-14 days
- Fluconazole 100 mg PO qd for 7-14 days
- Clotrimazole
- Esophageal
- Fluconazole 100-200 mg PO/IV qd for 14-21 days
- Amphotericin B 0.3 mg/kg/day for 5-10d
- Indicated for severe cases only
- Ketoconazole 200-400 mg orally daily for 14-21 days
- Indicated only for severe, refractory cases due to Ketoconazole hepatotoxicity
- If Ketoconazole is used, requires Liver Function Tests at baseline and again weekly
- Cutaneous
- Management: Urinary Tract Candidiasis (Candiduria)
- Asymptomatic Candiduria (on Urinalysis) does not require treatment unless otherwise indicated
- Pre-Urologic procedure and Candiduria
- Fluconazole (Diflucan) 3-6 mg/kg to 200-400 mg orally or IV once daily for 2-3 days before and after procedure OR
- Amphotericin B 0.3 to 0.6 mg/kg once daily for 2-3 days before and after procedure
- Symptomatic Candiduria (or asymptomatic with risks)
- Indications for treatment in asymptomatic patients
- Neutropenia
- Low Birth Weight Infant
- Pregnancy
- First-line agents
- Fluconazole (Diflucan) 3 mg/kg up to 200 mg orally or IV once daily for 14 days
- Increase dose to 6 mg/kg up to 400 mg orally daily for Pyelonephritis
- Fluconazole (Diflucan) 3 mg/kg up to 200 mg orally or IV once daily for 14 days
- Alternative Agents (e.g. Fluconazole resistance)
- Amphotericin B 0.5 mg/kg once daily for 7 days (14 days for Pyelonephritis) OR
- If Urinary Catheter, may irrigate with Amphotericin B 50 mg in 1L x5-7 days
- Flucytosine 25 mg/kg four times daily for 14 days
- Amphotericin B 0.5 mg/kg once daily for 7 days (14 days for Pyelonephritis) OR
- Indications for treatment in asymptomatic patients
- References
- Management: Disseminated
- Empiric broad Candidiasis coverage or known resistant Candidiasis (Candida glabrata or Candida krusei)
- Caspofungin 70 mg IV load, then 50 mg IV every 24 hours or
- Micafungin 100 mg IV every 24 hours or
- Anidulafungin 200 mg IV load, then 100 mg IV every 24 hours
- Known Candida albicans or Candida parapsilosis or Candida tropicalis
- Fluconazole 800 mg (12 mg/kg) load then 400 mg IV or oral daily
- Alternative empiric protocols
- Amphotericin B 0.7 mg/kg IV daily (or lipid based Amphotericin B 3-5 mg/kg daily) or
- Fluconazole 800 mg (or 12 mg/kg) load then 400 mg IV or oral daily or
- Voriconazole 400 mg (or 6 mg/kg) IV twice daily for 2 doses, followed by 200 mg every 12 hours
- References
- Gilbert (2013) Sanford Antibiotic Guide
- Empiric broad Candidiasis coverage or known resistant Candidiasis (Candida glabrata or Candida krusei)