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Managing Candidiasis: Updated Guidelines

Managing Candidiasis: Updated Guidelines

The Infectious Diseases Society of America (IDSA) last updated their guideline on the management of candidiasis in 2009. Since that time, new data have emerged on the diagnosis, prevention, and treatment of this major cause of morbidity and mortality, leading to an update to IDSA’s recommendations that was recently released. “Among the most important studies during this time were those that assessed first-line therapy with echinocandins versus azoles,” says Peter G. Pappas, MD, lead author of the guideline update. This new research shows that echinocandins—which kill the fungus—are more effective than azoles—which prevent the fungus from growing—in treating invasive infections. “The data support our key recommendation to start most patients with candidiasis on echinocandins and then step down to an azole.” Judicious Prophylaxis The updated guideline also addresses the importance of judiciously using prophylaxis. It is important to understand which patient populations are mostly likely to benefit from prophylaxis, including ICU patients and transplant recipients. ICU patients who stand to benefit most from prophylaxis include patients: Who have been on antibiotics. Have central venous catheters. Are on a ventilator. Have pancreatitis or recent abdominal surgery. Are immunosuppressed. Have skin burns. “Transplant patients who would benefit most from prophylaxis include high-risk liver transplant recipients, those with modified renal function, and those with prolonged operations who require blood products,” adds Dr. Pappas. Clinicians are also advised to suspect candidiasis in patients who are deteriorating without an obvious reason, have unexplained fever, and have elevated white blood cell counts.   The Importance of Early Care A key theme throughout the guideline update is the importance of early recognition and initiation of therapy...
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