Clinical Practice Guidelines for the Management Candidiasis: 2009 Update by the Infectious Diseases Society of America
Open accessAbstract
Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.
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The 2009 IDSA guidelines recommended echinocandins only for neutropenic patients and patients with previous exposure to antifungals.
“In contrast with the 2009 Infectious Disease Society of America guidelines for the treatment of invasive candidiasis, in which echinocandins were recommended only for neutropenic patients and patients with previous exposure to antifungals (64)”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — Four Sites, United States, 2012–2016 (2019) · cites this paper as [64]
The recommendations for candidemia in nonneutropenic patients (page not supplied) list an echinocandin as initial therapy for most adults, not only for neutropenic patients or those previously exposed to antifungals. They also favor an echinocandin for moderately severe to severe illness, independently of recent azole exposure. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredConsensus guidelines suggest a combination of amphotericin B and flucytosine for some infection types such as Candida meningitis, endophthalmitis, and endocarditis.
“Consensus guidelines do suggest a combination of amphotericin B and flucytosine for some infection types such as Candida meningitis, endophthalmitis, and endocarditis.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [110]
The IDSA guideline for invasive candidiasis recommends a 2-week treatment duration following clearance of Candida from the bloodstream and resolution of symptoms attributable to candidemia.
“The IDSA guideline for invasive candidiasis recommends a 2-week treatment duration following clearance of Candida from the bloodstream and resolution of symptoms attributable to candidemia.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [110]
Longer durations are recommended for persistent candidemia and for metastatic infection involving other sites (CNS, bone, endocarditis, joint/prosthetic joint infection).
“Longer durations are recommended for persistent candidemia and for metastatic infection involving other sites (ie, CNS, bone, endocarditis, joint/ prosthetic joint infection).”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [110]
Treatment guidelines recommend step down to fluconazole for patients who have improved clinically after initial therapy with an echinocandin or amphotericin B and who are infected with an organism likely susceptible to fluconazole (e.g., C. albicans, C. parapsilosis, C. tropicalis) or if there is documented susceptibility based on laboratory MIC testing.
“Treatment guidelines recommend step down to fluconazole for patients who have improved clinically after initial therapy with an echinocandin or amphotericin B and who are infected with an organism that is likely to be susceptible to fluconazole (eg, C albicans, C parapsilosis, and C tropicalis) or if there is documented susceptibility based on laboratory MIC testing.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [110]
Therefore, the current guidelines suggest ophthalmologic examination for every patient with candidemia.
“Therefore, the current guidelines suggest ophthalmologic examination for every patient with candidemia.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [110]
Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (i.e., Candida) based on evidence from large retrospective and observational studies.
“Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (ie, Candida) based on evidence from large retrospective and observational studies.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [110]
The American Society of Infectious Diseases recommends that patients should use topical and oral azoles concurrently.
“Thus, the American Society of Infectious Diseases recommends that patients should use topical and oral azoles concurrently [38].”
From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [38]
The echinocandins have been recommended as first-line agents for invasive candidiasis.
“They display in vitro fungicidal activity against most Candida species, attractive tolerability and pharmacokinetic profiles, and have been recommended as first line agents for invasive candidiasis (1–6).”
From Echinocandin resistance: an emerging clinical problem? (2014) · cites this paper as [6]
The echinocandins display in vitro fungicidal activity against most Candida species.
“They display in vitro fungicidal activity against most Candida species, attractive tolerability and pharmacokinetic profiles, and have been recommended as first line agents for invasive candidiasis (1–6).”
From Echinocandin resistance: an emerging clinical problem? (2014) · cites this paper as [6]
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Self-citation
- Authors
- Pappas, P. G., Kauffman, C. A., Andes, D., Benjamin, D. K., Calandra, T. F., Edwards, J. E., Filler, S. G., Fisher, J. F., Kullberg, B.-J., Zeichner, L. O., Reboli, A. C., Rex, J. H., Walsh, T. J., & Sobe, J. D.
- Affiliations
- University of Alabama at Birmingham (US)
- University of Michigan (US)
- University of Wisconsin–Madison (US)
- Duke Medical Center (US)
- Centre Hospitalier Universitaire Vaudois (CH)
- University of California, Los Angeles (US)
- Augusta University (US)
- Radboud University Nijmegen (NL)
- University of Texas at Houston, Houston
- Cooper University Hospital (US)
- AstraZeneca (United Kingdom) (GB)
- National Cancer Institute (US)
- Wayne State University (US)
- Corresponding author
- Pappas, Peter G.
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-03-01
- Volume
- 48
- Issue
- 5
- Pages
- 503-535
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC7294538
- OpenAlex
- W2150428940
- Cited by
- 3,191
- References
- 305
- Citations by year
- 2026: 23 · 2025: 41 · 2024: 49 · 2023: 55 · 2022: 65 · 2021: 121 · 2020: 155 · 2019: 149 · 2018: 149 · 2017: 195 · 2016: 226 · 2015: 327 · 2014: 312 · 2013: 311 · 2012: 319
- FWCI
- 230.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- SERVAL (Université de Lausanne) (publishedVersion, other-oa)
- PubMed Central (acceptedVersion)
- reroDoc Digital Library (submittedVersion)
- IRIS (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Amgen
- Pfizer
- AstraZeneca
- Gilead Sciences
- Infectious Diseases Society of America
- Astellas Pharma
- Basilea Pharmaceutica
- National Institutes of Health
- Centers for Disease Control and Prevention
- Pfizer Pharmaceuticals
- National Cancer Institute (Z01SC006830)
- National Institute of Child Health and Human Development
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Keywords
- invasive candidiasis, mucosal candidiasis, candidemia, oropharyngeal candidiasis, esophageal candidiasis, antifungal agents, empirical antifungal therapy, high-risk infants, high-risk adults
- MeSH terms
- Antifungal Agents, Candidiasis, Humans
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