Practice guidelines for the treatment of candidiasis

Infections due to Candida species are the most common of the fungal infecti ons. Candida species produce a broad range of infections, ranging from non- life-threatening mucocutaneous illnesses to invasive process that may invol ve virtually any organ. Such a broad range of infections requires an equall y broad range of diagnostic and therapeutic strategies. This document summa rizes current knowledge about treatment of multiple forms of candidiasis an d is the guideline of the Infectious Diseases Society of America (IDSA) for the treatment of candidiasis. Throughout this document, treatment recommen dations are scored according to the standard scoring scheme used in other I DSA guidelines to illustrate the strength of the underlying data. The docum ent covers 4 major topical areas. The role of the microbiology laboratory. To a greater extent than for other fungi, treatment of candidiasis can now be guided by in vitro susceptibili ty testing. The guidelines review the available information supporting curr ent testing procedures and interpretive breakpoints and place these data in to clinical context. Susceptibility testing is most helpful in dealing with infection due to non-albicans species of Candida. In this setting, especia lly if the patient has been treated previously with an azole antifungal age nt, the possibility of microbiological resistance must be considered. Treatment of invasive candidiasis. In addition to acute hematogenous candid iasis, the guidelines review strategies for treatment of 15 other forms of invasive candidiasis. Extensive data from randomized trials are really avai lable only for therapy of acute hematogenous candidiasis in the nonneutrope nic adult. Choice of therapy for other forms of candidiasis is based on cas e series and anecdotal reports. In general, both amphotericin B and the azo les have a role to play in treatment. Choice of therapy is guided by weighi ng the greater activity of amphotericin B for some non-albicans species (e. g., Candida krusei) against the lesser toxicity and ease of administration of the azole antifungal agents. Flucytosine has activity against many isola tes of Candida but is not often used. Treatment of mucocutaneous candidiasis. Therapy for mucosal infections is d ominated by the azole antifungal agents. These drugs may be used topically or systemically and have been proven safe and efficacious. A significant pr oblem with mucosal disease is the is the propensity for a small proportion of patients to suffer repealed relapses. in some situations. the explanatio n for such a relapse is obvious (e.g., relapsing oropharyngeal candidiasis in an individual with advanced and uncontrolled HIV infection), but in othe r patients the cause is cryptic (e.g., relapsing vaginitis in a healthy wom an). Rational strategies for these situations are discussed in the guidelin es and must consider the possibility of induction of resistance over time. Prevention of invasive candidiasis. Prophylactic strategies are useful if t he risk of a target disease is sharply elevated in a readily identified gro up of patients. Selected patient groups undergoing therapy that produces pr olonged neutropenia (e.g., some bone-marrow transplant recipients) or who r eceive a solid-organ transplant (e.g., some liver transplant recipients) ha ve a sufficient risk of invasive candidiasis to warrant prophylaxis.