From the Guidelines
The most effective treatment for candidiasis is an echinocandin, such as caspofungin, micafungin, or anidulafungin, as initial therapy for most adult patients, especially those with moderately severe to severe illness or recent azole exposure, as recommended by the Infectious Diseases Society of America 1.
Treatment Options
The treatment options for candidiasis include:
- Echinocandins (caspofungin, micafungin, anidulafungin) as initial therapy for most adult patients
- Fluconazole for patients who are less critically ill and have had no recent azole exposure
- Amphotericin B deoxycholate or a lipid formulation of AmB as alternatives if there is intolerance to or limited availability of other antifungals
- Voriconazole for selected cases of candidiasis due to Candida krusei or voriconazole-susceptible C. glabrata
Specific Treatment Recommendations
- For infection due to Candida albicans, fluconazole is recommended
- For infection due to Candida glabrata, an echinocandin is preferred
- For infection due to Candida parapsilosis, treatment with fluconazole is recommended
- For patients who have initially received an echinocandin, are clinically improved, and whose follow-up culture results are negative, continuing use of an echinocandin is reasonable
Important Considerations
- The treatment approach should be individualized based on the patient's clinical presentation, microbiological findings, and response to therapy
- The choice of antifungal therapy should be guided by the susceptibility of the Candida species and the patient's underlying medical conditions
- Patients with recurrent or complicated candidiasis may require longer courses of treatment or alternative therapies, as recommended by the Infectious Diseases Society of America 1.
From the FDA Drug Label
Dosage and Administration in Adults: Single Dose Vaginal candidiasis: The recommended dosage of fluconazole tablets for vaginal candidiasis is 150 mg as a single oral dose. Oropharyngeal candidiasis: The recommended dosage of fluconazole tablets for oropharyngeal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Esophageal candidiasis: The recommended dosage of fluconazole tablets for esophageal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Systemic Candida infections: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia, optimal therapeutic dosage and duration of therapy have not been established. Urinary tract infections and peritonitis: For the treatment of Candida urinary tract infections and peritonitis, daily doses of 50 to 200 mg have been used in open, noncomparative studies of small numbers of patients.
The treatment options for candidiasis (fungal infection) include:
- Fluconazole:
- Vaginal candidiasis: 150 mg as a single oral dose
- Oropharyngeal candidiasis: 200 mg on the first day, followed by 100 mg once daily
- Esophageal candidiasis: 200 mg on the first day, followed by 100 mg once daily
- Systemic Candida infections: optimal therapeutic dosage and duration of therapy have not been established
- Urinary tract infections and peritonitis: daily doses of 50 to 200 mg
- Voriconazole:
From the Research
Treatment Options for Candidiasis
The treatment options for candidiasis, a fungal infection, include:
- Fluconazole, which is well established as a first-line management option for the treatment and prophylaxis of localized and systemic Candida albicans infections 4
- Itraconazole, which can be used as a second-line therapy for patients who do not respond to fluconazole 4
- Clotrimazole, which can be used as an intravaginal treatment for vaginal candidiasis 5
- Terbinafine, which may be an alternative treatment option for vulvovaginal candidiasis, although it is not recommended as a first-line treatment 6
- Voriconazole, which is a broad-spectrum triazole derivative that can be used to treat invasive fungal infections, including candidiasis 7
Antifungal Agents
The following antifungal agents can be used to treat candidiasis:
- Triazole antifungals, such as fluconazole, voriconazole, and itraconazole, which have emerged as front-line drugs for the treatment and prophylaxis of many systemic mycoses 8
- Posaconazole, which has a wide spectrum of activity and is primarily used as salvage therapy for patients with invasive aspergillosis and prophylaxis for patients with neutropenia and haematopoietic stem-cell transplant recipients 8
Administration and Pharmacokinetics
The administration and pharmacokinetics of these antifungal agents vary:
- Fluconazole and voriconazole are well absorbed and exhibit high oral bioavailability 8
- Itraconazole and posaconazole have lower and more variable oral bioavailability 8
- Posaconazole absorption depends on administration with a high-fat meal or nutritional supplements 8
- Therapeutic drug monitoring (TDM) is recommended for voriconazole, itraconazole, and posaconazole to ensure target drug concentrations are reached 8