2000;30:662–78 | John H. Rex, Thomas J. Walsh, Jack D. Sobel, Scott G. Filler, Peter G. Pappas, William E. Dismukes, John E. Edwards
This document provides a comprehensive overview of the treatment guidelines for candidiasis, a fungal infection caused by *Candida* species. The guidelines are developed by the Infectious Diseases Society of America (IDSA) and cover four major areas: the role of the microbiology laboratory, treatment of invasive candidiasis, treatment of mucocutaneous candidiasis, and prevention of invasive candidiasis. Key points include:
1. **Microbiology Laboratory**: In vitro susceptibility testing is crucial for guiding treatment, especially for non-albicans species. Interpretive breakpoints for azole antifungal agents are provided, emphasizing the importance of considering microbiological resistance.
2. **Treatment of Invasive Candidiasis**: Amphotericin B and azoles are commonly used, with amphotericin B being more effective against non-albicans species. The choice of therapy depends on the patient's clinical status and the species of *Candida*. Lipid-based formulations of amphotericin B are available for patients who are intolerant or refractory to conventional amphotericin B.
3. **Treatment of Mucocutaneous Candidiasis**: Azole antifungal agents are the primary treatment for mucosal infections, which can be administered topically or systemically. Relapse is a significant issue, and strategies to prevent relapses are discussed.
4. **Prevention of Invasive Candidiasis**: Prophylactic strategies are recommended for high-risk patient groups, such as those undergoing prolonged neutropenia or solid-organ transplantation.
The guidelines also provide detailed recommendations for specific forms of candidiasis, including candidemia, disseminated candidiasis, chronic disseminated candidiasis, neonatal candidiasis, urinary candidiasis, candidal pneumonia, laryngeal candidiasis, candidal osteomyelitis, candidal infections of the gallbladder, pancreas, and peritoneum, candidal endocarditis, pericarditis, and suppurative phlebitis, candidal meningitis, and nongenital mucocutaneous candidiasis. Each section includes objectives, treatment options, outcomes, evidence, values, benefits, harms, and costs, as well as key recommendations.This document provides a comprehensive overview of the treatment guidelines for candidiasis, a fungal infection caused by *Candida* species. The guidelines are developed by the Infectious Diseases Society of America (IDSA) and cover four major areas: the role of the microbiology laboratory, treatment of invasive candidiasis, treatment of mucocutaneous candidiasis, and prevention of invasive candidiasis. Key points include:
1. **Microbiology Laboratory**: In vitro susceptibility testing is crucial for guiding treatment, especially for non-albicans species. Interpretive breakpoints for azole antifungal agents are provided, emphasizing the importance of considering microbiological resistance.
2. **Treatment of Invasive Candidiasis**: Amphotericin B and azoles are commonly used, with amphotericin B being more effective against non-albicans species. The choice of therapy depends on the patient's clinical status and the species of *Candida*. Lipid-based formulations of amphotericin B are available for patients who are intolerant or refractory to conventional amphotericin B.
3. **Treatment of Mucocutaneous Candidiasis**: Azole antifungal agents are the primary treatment for mucosal infections, which can be administered topically or systemically. Relapse is a significant issue, and strategies to prevent relapses are discussed.
4. **Prevention of Invasive Candidiasis**: Prophylactic strategies are recommended for high-risk patient groups, such as those undergoing prolonged neutropenia or solid-organ transplantation.
The guidelines also provide detailed recommendations for specific forms of candidiasis, including candidemia, disseminated candidiasis, chronic disseminated candidiasis, neonatal candidiasis, urinary candidiasis, candidal pneumonia, laryngeal candidiasis, candidal osteomyelitis, candidal infections of the gallbladder, pancreas, and peritoneum, candidal endocarditis, pericarditis, and suppurative phlebitis, candidal meningitis, and nongenital mucocutaneous candidiasis. Each section includes objectives, treatment options, outcomes, evidence, values, benefits, harms, and costs, as well as key recommendations.