2004;38:161-89 | Peter G. Pappas, John H. Rex, Jack D. Sobel, Scott G. Filler, William E. Dismukes, Thomas J. Walsh, and John E. Edwards
The guidelines provide comprehensive recommendations for the treatment of various forms of candidiasis, emphasizing the importance of accurate species identification and susceptibility testing. The document covers four major areas: the role of the microbiology laboratory, treatment of invasive candidiasis, treatment of mucocutaneous candidiasis, and available drugs and drug use. Key recommendations include:
1. **Microbiology Laboratory**: Susceptibility testing is crucial, especially for deep infections due to non-*albicans* species. Interpretive breakpoints are provided for fluconazole, itraconazole, and flucytosine, with a focus on dose-dependent susceptibility.
2. **Invasive Candidiasis**: Treatment options include amphotericin B, azole antifungal agents, and echinocandin antifungal agents. Amphotericin B is generally recommended for severe infections, while azoles are preferred for mucosal infections. Echinocandins are effective for oropharyngeal and esophageal candidiasis.
3. **Mucocutaneous Candidiasis**: Azole antifungal agents are the primary treatment, with topical and systemic options available. Relapse is a significant issue, and rational stratification is essential for successful management.
4. **Available Drugs and Drug Use**: Newer antifungal drugs like voriconazole and caspofungin are licensed, but their use is limited by the lack of extensive clinical data. Amphotericin B deoxycholate remains the standard for invasive candidiasis, with lipid-associated formulations available for refractory cases.
The guidelines also address specific conditions such as candidemia, disseminated candidiasis, and chronic disseminated candidiasis, providing detailed recommendations for treatment, outcomes, evidence, values, benefits, harms, and costs.The guidelines provide comprehensive recommendations for the treatment of various forms of candidiasis, emphasizing the importance of accurate species identification and susceptibility testing. The document covers four major areas: the role of the microbiology laboratory, treatment of invasive candidiasis, treatment of mucocutaneous candidiasis, and available drugs and drug use. Key recommendations include:
1. **Microbiology Laboratory**: Susceptibility testing is crucial, especially for deep infections due to non-*albicans* species. Interpretive breakpoints are provided for fluconazole, itraconazole, and flucytosine, with a focus on dose-dependent susceptibility.
2. **Invasive Candidiasis**: Treatment options include amphotericin B, azole antifungal agents, and echinocandin antifungal agents. Amphotericin B is generally recommended for severe infections, while azoles are preferred for mucosal infections. Echinocandins are effective for oropharyngeal and esophageal candidiasis.
3. **Mucocutaneous Candidiasis**: Azole antifungal agents are the primary treatment, with topical and systemic options available. Relapse is a significant issue, and rational stratification is essential for successful management.
4. **Available Drugs and Drug Use**: Newer antifungal drugs like voriconazole and caspofungin are licensed, but their use is limited by the lack of extensive clinical data. Amphotericin B deoxycholate remains the standard for invasive candidiasis, with lipid-associated formulations available for refractory cases.
The guidelines also address specific conditions such as candidemia, disseminated candidiasis, and chronic disseminated candidiasis, providing detailed recommendations for treatment, outcomes, evidence, values, benefits, harms, and costs.