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Table 3 Treatment of localized candidiasis

From: How to treat fungal infections in ICU patients

  Primary therapy Alternative therapy
Pyelonephritis Fluconazole 200–400 mg for 14 days Amphotericin B deoxycholate 0.5-0.7 mg/kg daily +/− flucytosine 25 mg/kg four times daily or flucytosine alone for 14 days
Osteomyelitis Fluconazole 400 mg daily for 6–12 months Echinocandin* or Amphotericin B deoxycholate 0.5-1 mg/kg daily for several weeks and then fluconazole for 6–12 months
Lipid formulations of amphotericin B 3–5 mg/kg daily for several weeks, then fluconazole for 6–12 months
Septic arthritis Fluconazole 400 mg daily for at least 6 weeks Echinocandin* or Amphotericin B deoxycholate 0.5-1 mg/kg daily for several weeks and then fluconazole
Lipid formulations of amphotericin B 3–5 mg/kg daily for several weeks, then followed by fluconazole
CNS candidiasis Lipid formulations of amphotericin B 3–5 mg/kg +/− flucytosine 25 mg/kg four times daily for several weeks, followed by fluconazole 400–800 mg daily until the resolution of symptoms Fluconazole 400–800 mg daily for patients intolerant to lipid formulations of amphotericin B
Endophthalmitis Amphotericin B deoxycholate 0.7-1 mg/kg with flucytosine 25 mg/kg four times daily for at least 4–6 weeks along with surgical intervention for severe cases Lipid formulations of amphotericin B 3–5 mg/kg daily
Voriconazole 6 mg/kg twice daily for two doses, then 3–4 mg/kg twice daily
Echinocandin*
Endocarditis Lipid formulations of amphotericin B 3–5 mg/kg +/− flucytosine 25 mg/kg four times daily Valve replacement is strongly recommended, otherwise chronic suppression with fluconazole 400–800 mg daily is recommended. Lifelong suppressive therapy for prosthetic valve endocarditis if valve cannot be replaced is recommended.
Amphotericin B deoxycholate 0.6-1 mg/kg +/− flucytosine 25 mg/kg four times daily
Echinocandin**
  1. *Anidulafungin 200 mg loading dose, then 100 mg/day; Caspofungin 70 mg loading dose, then 50 mg/day; Micafungin 100 mg/day.
  2. **For endocarditis higher doses of echinocandins may be required such as Anidulafungin 100–200 mg/day; Caspofungin 50–150 mg/day; Micafungin 100–150 mg/day.