Recommendations
| Дозування | Ремарки | |
|---|---|---|
|
1st choice
|
In endophthalmitis (vitreous invasion) also perform a vitrectomy and leave intravitreal amphotericin B (deoxycholate) 5-10 µg/0,1 ml or intravitreal voriconazole 100-200 µg/0,1 ml |
| Дозування | Ремарки | |
|---|---|---|
|
Consult the microbiologist/infectious diseases specialist |
| Дозування | Ремарки | |
|---|---|---|
|
1st choice
|
fluconazole IV loading dose 800 mg, then 400 mg once daily
|
Duration: depends on clinical course, at least 6 weeks If there is candidemia, also add an echinocandin; see also MYC1.1 candidemia Indication for step-down therapy, see* |
| Дозування | Ремарки | |
|---|---|---|
|
1st choice
|
voriconazole IV loading dose 6 mg/kg, then 4 mg/kg twice daily
|
Voriconazole 6 mg/kg twice daily on day 1, followed by 4 mg/kg twice daily on day 2 and thereafter. Duration: depends on clinical course, at least 6 weeks If there is candidemia, also add an echinocandin; see also MYC1.1 candidemia Indication for step-down therapy, see* |
| Дозування | Ремарки | |
|---|---|---|
|
1st choice
|
liposomal amphotericin B (Ambisome) IV 3 mg/kg once daily
+ flucytosine IV 25 mg/kg four times daily |
Duration: depends on clinical course, at least 6 weeks
Therapeutic drug monitoring (TDM) is necessary for flucytosine: Flucytosine (5-FC) (tdm-monografie.org) Flucytosine is contraindicated in patients with dihydropyrimidine dehydrogenase (DPD) deficiency. However, pre-testing is not necessary given the rarity of this deficiency. |
Oral step-down treatment in consultation with the mycology MDT
If candidemia is present, also add an echinocandin; see also MYC 1.1 candidemia
* After ≥5 days of echinocandin therapy and in patients with clinical improvement, haemodynamically stabilised patients, negative follow-up blood cultures, and demonstrated susceptibility. This does not apply to C. glabrata, C. krusei, or patients with Candida endocarditis, intravascular candidiasis, retained central venous lines, or prosthesis-associated candidiasis.