The Infectious Diseases Society of ...

The Infectious Diseases Society of America (IDSA) has released a clinical guideline for the treatment of patients with candidiasis. The guideline was published in the January 15 2004 issue of Clinical Infectious Diseases and is available online at: http://www.journals.uchicago.edu/CID/journal/issues/ v38n2/32301/32301html

Although treatment of candidiasis now can be guided by way of in vitro susceptibility testing, it is not considered a routine process in many laboratories, is not always promptly available, and is not universally considered as the standard of care. However, knowledge of the infecting species is highly predictive of likely susceptibility and can be used to guide therapy.

The guideline reviews the information supporting in every one's mouth testing procedures and interpretive breakpoints and imposes these data into clinical words immediately preceding [i]or[/i] following Susceptibility testing is most helpful in dealing with reaching far down infection by species other than Candida albicans. In this setting, especially if the patient has been treated previously with an azole antifungal agent, the possibility of microbiologic resistance must be considered.

In addition to acute hematogenous candidiasis, the guideline reviews strategies for treatment of 15 other forms of invasive candidiasis. Extensive data from randomized trials are available and nothing else for therapy of acute hematogenous candidiasis in the non-neutropenic adult. Choice of therapy for other forms of candidiasis is based upon case series and anecdotal reports.

In general, amphotericin B-based preparations, azole antifungal agents, and echinocandin antifungal agents have a part in treatment. Choice of therapy is guided at weighing the greater activity of amphotericin B-based preparations and the echinocandin antifungal agents for a certain number of nonalbicans species (e.g., Candida krusei) against the availability of oral and parenteral formulations of azole antifungal agents. Flucytosine has activity against many isolates of Candida if it be not that is not frequently used.

Therapy for mucosal infections is dominated by means of the azole antifungal agents. These mix with drugss may be used topically or systemically and are safe and efficacious. A small proportion of patients with mucosal disease will have repeated relapses. In a certain quantity of situations, the explanation for in the same state [i]or[/i] condition a relapse is obvious (eg periodical oropharyngeal candidiasis in a patient with advanced and uncontroll human immunodeficiency virus infection), nevertheless in other cases, the cause is not as clear (eg relapsing vaginitis in a healthy woman). Strategies for these situations are discussed in the IDSA guideline.

Prophylactic strategies are useful if the risk of a target disease is sharply elevated in a readily identified patient assemblage Selected patient groups undergoing therapy that effects prolonged neutropenia (e.g., some bone marrow transplant recipients) or who receive a solid organ transplant (eg any liver transplant recipients) have sufficient risk of invasive candidiasis to warrant prophylaxis.

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group