What is the treatment for Invasive Candidiasis?

From the Guidelines

The treatment of invasive candidiasis should involve systemic antifungal therapy with echinocandins as first-line agents, specifically caspofungin (70 mg loading dose, then 50 mg daily), micafungin (100 mg daily), or anidulafungin (200 mg loading dose, then 100 mg daily), as recommended by the Infectious Diseases Society of America 1. The choice of antifungal agent is crucial in the management of invasive candidiasis, and the selection should be based on the patient's clinical presentation, underlying conditions, and potential resistance patterns.

• Key considerations in the treatment of invasive candidiasis include:
  • The use of echinocandins as initial therapy due to their broad spectrum of activity and favorable safety profile 1
  • The potential for step-down therapy to fluconazole (800 mg loading dose, then 400 mg daily) in stable patients with susceptible isolates, provided there has been no recent azole exposure and no colonization with azole-resistant Candida species 1
  • The role of lipid formulation amphotericin B (3-5 mg/kg daily) as an alternative in cases of intolerance to other antifungal agents 1
• The duration of therapy is also an important consideration, with a recommended duration of at least 2 weeks for both empiric therapy and treatment of documented candidemia 1.
• Source control, including the removal of infected intravascular catheters and drainage of abscesses, is essential in the management of invasive candidiasis.
• Monitoring with follow-up blood cultures is necessary to ensure clearance of the infection and to guide adjustments in therapy, particularly for non-albicans Candida species which may exhibit resistance patterns.

From the FDA Drug Label

14.1 Treatment of Candidemia and Other Candida Infections in Adult and Pediatric Patients 4 Months of Age and Older Two dose levels of micafungin for injection were evaluated in a randomized, double-blind study to determine the efficacy and safety versus caspofungin in patients with invasive candidiasis and candidemia Patients were randomized to receive once daily intravenous infusions (IV) of micafungin for injection, either 100 mg/day or 150 mg/day or caspofungin (70 mg loading dose followed by 50 mg maintenance dose)

The treatment for Invasive Candidiasis is micafungin for injection at a dose of 100 mg/day or 150 mg/day, or caspofungin at a dose of 70 mg loading dose followed by 50 mg maintenance dose 2.

• Key treatment options:
  • Micafungin for injection: 100 mg/day or 150 mg/day
  • Caspofungin: 70 mg loading dose followed by 50 mg maintenance dose
• Administration: Once daily intravenous infusions (IV)

From the Research

Treatment Options for Invasive Candidiasis

The treatment for invasive candidiasis typically involves the use of antifungal agents. The choice of treatment depends on various factors, including the severity of the illness, the presence of risk factors for azole resistance, and the specific patient population.

Echinocandins as Primary Therapy

• Echinocandins, such as anidulafungin, caspofungin, and micafungin, have emerged as important agents for the treatment of invasive candidiasis 3, 4, 5.
• These agents have been shown to have high response rates and excellent side-effect profiles, making them a preferred choice for primary therapy in patients who are severely ill and/or have risk factors for azole resistance 3.
• The selection of an echinocandin should be based on the specific patient population, including clinical status, the suspected pathogen, and the susceptibility pattern at the institution 3.

Comparison of Echinocandins

• Studies have compared the efficacy and safety of different echinocandins, including micafungin, caspofungin, and anidulafungin 4, 6.
• Micafungin has been shown to be non-inferior to caspofungin and liposomal amphotericin B for the treatment of candidemia and invasive candidiasis 4, 6.
• Anidulafungin has been shown to have higher response rates compared to fluconazole in patients with invasive candidiasis 3.

Other Treatment Options

• Amphotericin B deoxycholate and fluconazole may be considered for initial therapy in specific populations, such as patients with less severe illness or those without risk factors for azole resistance 3.
• Azoles and liposomal amphotericin B can be used as second-line treatments in cases of fungal resistance or hypersensitivity 7.

Step-Down Therapy

• Once the Candida species is identified and its susceptibility is determined, clinicians should consider step-down therapy to either fluconazole or voriconazole, with possible conversion from intravenous to oral therapy 3.