Home Undefined

MYC 1.1 Candida: Candidemia/disseminated candidiasis

Content version
U-112.2
Updated
10/20/2025 - 14:39

Recommendations

≥ 18 years
Dosage Remarks
1st choice
anidulafungin iv loading dose 200 mg, 100 mg once daily

or

caspofungin iv loading dose 70 mg, 50 mg once daily

or

micafungin iv 100 mg once daily

Candidemia/invasive candidiasis regardless of species and azole susceptibility.

This therapy is inadequate for Candida meningitis, endophthalmitis or urinary tract infection; see comments.
1st choice
anidulafungin iv loading dose 200 mg, 100 mg once daily

or

caspofungin iv loading dose 70 mg, 50 mg once daily

or

micafungin iv 100 mg once daily

Candida glabrata candidemia/invasive candidiasis

Candida krusei candidemia/invasive candidiasis
2nd choice
liposomal amphotericin B (Ambisome) iv 3 mg/kg once daily

Candida glabrata candidemia/invasive candidiasis
2nd choice
voriconazole iv loading dose 6 mg/kg, then 4 mg/kg twice daily

or

liposomal amphotericin B (Ambisome) iv 3 mg/kg once daily

Candida krusei candidemia/invasive candidiasis

Voriconazole 6 mg/kg twice daily on day 1, followed by 4 mg/kg twice daily from day 2 onwards.
≥ 18 years

Indications: Step-down
Dosage Remarks
fluconazole iv loading dose 800 mg, then 400 mg once daily

Step-down after initial treatment with an echinocandin: For patients with clinical improvement, haemodynamically stabilised patients, negative follow-up blood cultures, and demonstrated fluconazole susceptibility. Not for C. glabrata, C. krusei, or for patients with Candida endocarditis, intravascular candidiasis, non-removed central venous lines, or prosthesis-associated candidiasis.

Comments

Because of the low incidence of ocular complications, routine fundoscopy is no longer recommended, except for patients who cannot adequately report symptoms (e.g. those remaining in the ICU).

Anidulafungin/micafungin/caspofungin do not penetrate well across the blood-brain barrier or into the aqueous humour. In suspected endophthalmitis, meningitis or candiduria/renal candidiasis, monotherapy with anidulafungin/micafungin is not adequate. Consult the clinical microbiologist/infectious disease specialist to adjust therapy.

For Candida meningitis, see CZS 1.14 meningitis – Candida spp

For endophthalmitis, see MYC 1.6 candida retinitis/endophthalmitis

For candiduria, see Candiduria / renal candidiasis | Radboud UMC