Invasive candida infections
- Discuss all cases with Micro/ID.
- Asymptomatic patients where C. albicans has been isolated do not necessarily require treatment. Discuss with Micro/ID if unsure.
- Fundoscopy or ophthalmology consult in patients with candidemia is recommended
- Antifungals (azoles especially) can interact with multiple medicines. Contact pharmacy for further advice.
- Avoid fluconazole in pregnancy.
- Echinocandins (e.g. caspofungin) are not usually recommended for urinary tract candidiasis.
- There are separate guidelines for critical care, haematology, oncology and transplant clinical areas. See appropriate guideline.
Candidaemia
- Positive blood culture with Candida species
If not critically ill or unlikely to have fluconazole resistant Candida: fluconazole 800mg po stat (loading dose) then 400mg po od for 14 days from date of the last positive blood culture (iv if patient NBM)
If likely to have fluconazole resistant Candida: Discuss with Micro/ID. caspofungin iv od see dosing table below.
| caspofungin IV dose | |
| Body weight up to 80kg |
Loading dose: 70mg iv od for day one Maintenance dose: 50mg iv od |
| Body weight 80kg or more |
Loading dose: 70mg iv od for day one Maintenance dose: 70mg iv od |
|
Concurrent use of enzyme inducers* (regardless of weight) |
Loading dose: 70mg iv od for day one Maintenance dose: 70mg iv od |
|
Moderate hepatic impairment (Child-Pugh score 7 to 9) (regardless of weight) |
Loading dose: 70mg iv od for day one Maintenance dose: 35mg iv od |
*Phenytoin, carbamazepine, dexamethasone or rifampicin. This list is not exhaustive, check BNF and SPC for interactions.
Candiduria without renal involvement
- Asymptomatic candiduria (Candida species) is common and usually does NOT need treatment.
- Consider removing indwelling urinary catheter if possible.
For patients with signs and symptoms of lower UTI: fluconazole 200mg po od for 14 days
Alternatives: Discuss with Micro/ID who may recommend:
flucytosine 25 mg/kg po qds for 14 days
OR
amphotericin B liposomal (Tillomed/Gilead/AmBisome) 3-5mg/kg iv od for 14 days
Renal candidiasis
- Consider removing or replacing nephrostomy tubes or stents if possible
For patients with signs and symptoms of upper UTI: fluconazole 400mg po od for 14 days
Alternatives: Discuss with Micro/ID who may recommend:
flucytosine 25 mg/kg po qds for 14 days
OR
amphotericin B liposomal (Tillomed/Gilead/AmBisome) 3-5mg/kg iv od for 14 days