A pilot study of the management of uncomplicated candidemia with a standardized protocol of amphotericin B

We evaluated an amphotericin treatment strategy on the basis of duration of candidemia and clinical findings. Patients without neutropenia who had unc omplicated candidemia received 200 mg of amphotericin B over 5-7 days if th ey had had less than or equal to 1 day of documented positive blood culture s (SC group) or a total of 500 mg of amphotericin B over 14-20 days if they had had >1 day of positive cultures (PC group). The clinical cure rate was 93% (95% confidence interval [CI], 77%-99%; n = 29 episodes) in the SC gro up, with no relapses (median followup, 272 days). The clinical cure rate wa s 83% (95% CI, 64%-94%; n = 29 episodes) in the PC group, with 1 relapse (4 .2%). The results of this pilot study suggest that patients with candidemia may be stratified into risk groups on the basis of the duration of positiv e blood cultures and other clinical findings. Decisions about the duration of therapy can be made 4-7 days after initiation of treatment. Carefully se lected patients with transient uncomplicated candidemia may be safely treat ed with a short course of amphotericin B. Further prospective validation of this concept should be undertaken particularly to evaluate the impact on l ow-frequency late complications (e.g., endophthalmitis).