From the Guidelines
Treatment of fungal arthritis should involve a combination of antifungal medications and surgical intervention, with fluconazole 400 mg (6 mg/kg) daily for 6 weeks or an echinocandin for 2 weeks followed by fluconazole for at least 4 weeks being a recommended treatment option 1. The choice of antifungal agent depends on the specific fungal pathogen, with fluconazole being effective for Candida arthritis.
- Key considerations in the treatment of fungal arthritis include:
- The use of systemic antifungal agents, such as fluconazole or an echinocandin, as initial therapy
- The importance of surgical drainage in all cases of septic arthritis, particularly in cases with significant synovial destruction or abscess formation 1
- The need for device removal in cases of septic arthritis involving a prosthetic device, with chronic suppression with fluconazole being an alternative if device removal is not possible 1
- The potential for delayed treatment to lead to permanent joint damage and disability, highlighting the need for aggressive and prompt treatment. Treatment duration is typically prolonged, often 6-12 months or longer, with monitoring of clinical response, inflammatory markers, and joint function being crucial in managing fungal arthritis 1.
From the Research
Treatment Options for Fungal Arthritis
- The treatment of fungal arthritis typically involves the use of antifungal agents, with options including polyenes, azoles, and echinocandins 2.
- Amphotericin B is a commonly used treatment for fungal arthritis, particularly for infections caused by Candida species 3, 4.
- Azole antifungal agents, such as fluconazole, itraconazole, voriconazole, and posaconazole, have also been used to treat fungal arthritis, with reports of success 5, 4.
- Echinocandins have been shown to be effective in the treatment of invasive candidiasis, including fungal arthritis, and may be considered as a first-line treatment option 6.
Duration and Dosage of Treatment
- The duration of treatment for fungal arthritis can vary, but typically ranges from 6 months to 2 years 5.
- The dosage of antifungal agents can also vary, with fluconazole typically given at a dose of 200-400 mg/d 5.
Surgical Intervention
- Surgical debridement may be necessary in some cases of fungal arthritis, particularly for infections involving artificial joints 3, 4.
- The removal of prosthetic material may be required in cases where the infection is associated with an artificial joint 3.
Mortality and Morbidity
- The mortality rate for systemic fungal infections, including fungal arthritis, can be high, ranging from 50% in some cases 3.
- Successful treatment of fungal arthritis requires prompt diagnosis and initiation of antifungal therapy, as well as careful management of any underlying conditions that may be contributing to the infection 5, 4.