Treatment of Fungal Wounds
The treatment of fungal wounds requires specific antifungal agents based on the causative organism, with fluconazole being the first-line therapy for most Candida species at a dose of 400 mg (6 mg/kg) daily for superficial infections, while deeper or resistant infections may require an echinocandin or amphotericin B formulation. 1
Initial Assessment and Diagnosis
- Identification of the causative fungal organism is essential before initiating treatment, ideally through culture and susceptibility testing 1
- For neutropenic patients, examination should be delayed until neutrophil recovery to avoid complications 1
- Decisions regarding treatment should be made jointly by an infectious disease physician and other specialists when appropriate (e.g., ophthalmologist for ocular involvement) 1
Treatment Options Based on Infection Type
Superficial Fungal Wounds (Skin and Soft Tissue)
For localized superficial infections:
- Topical antifungal agents such as miconazole, clotrimazole, or terbinafine are effective first-line treatments 2
- Azole drugs (miconazole, clotrimazole) are fungistatic and work well for yeast infections like Candida 2
- Allylamine drugs (terbinafine, naftifine) are fungicidal and preferred for dermatophyte infections 2
For more extensive superficial infections:
Deep or Invasive Fungal Wounds
For invasive Candida infections:
- Fluconazole 400 mg (6 mg/kg) daily for 6-12 months for susceptible isolates 1
- Alternatively, an echinocandin (caspofungin 50-70 mg daily, micafungin 100 mg daily, or anidulafungin 100 mg daily) for at least 2 weeks followed by fluconazole 1
- For fluconazole-resistant isolates, liposomal amphotericin B 3-5 mg/kg daily with or without flucytosine 1
For wounds with bone involvement (osteomyelitis):
For septic arthritis:
Special Considerations
Surgical Management
- Source control with appropriate drainage and/or debridement is essential for intra-abdominal fungal infections 1
- For fungal abscesses, surgical debridement is strongly recommended in addition to antifungal therapy 1
- For infected prosthetic devices, removal is recommended when feasible 1
Duration of Therapy
- Treatment should continue until all signs and symptoms have resolved 1
- For deep tissue infections, treatment typically lasts 6-12 months 1
- For septic arthritis, treatment should continue for at least 6 weeks 1
Resistant Organisms
- For fluconazole-resistant Candida species:
- Echinocandins (caspofungin, micafungin, anidulafungin) are recommended as first-line therapy 1
- Liposomal amphotericin B 3-5 mg/kg daily is an alternative 1
- Voriconazole may be used for susceptible isolates at a loading dose of 400 mg (6 mg/kg) twice daily for 2 doses, then 200-300 mg (3-4 mg/kg) twice daily 1, 3
Prevention of Recurrence
- Prophylactic antifungal wash (ketoconazole/clotrimazole) can minimize chances of recurrence in superficial fungal infections 4
- Elimination of predisposing factors is crucial for preventing recurrence 1
- For patients with implanted devices that cannot be removed, chronic suppressive therapy with fluconazole is recommended if the isolate is susceptible 1