FAILURE OF THERAPY WITH FLUCONAZOLE FOR CANDIDAL ENDOPHTHALMITIS

The incidence of candidemia and its complications, such as endophthalm itis, has measurably increased in recent years. However, the optimal m ethod of treatment of hematogenous candidal infection remains a contro versial issue. Traditional therapy with amphotericin B is associated w ith well-known adverse reactions. Many clinicians therefore prefer to use fluconazole, which is administered orally and is relatively less t oxic. We recently observed a patient with candidal sepsis in whom blin ding endophthalmitis developed despite aggressive and lengthy therapy with fluconazole. This grave clinical outcome and the data derived fro m experimental models of ocular candidal infection suggest that empiri cal usage of fluconazole may not be warranted in cases of disseminated candidiasis potentially complicated by endophthalmitis.