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Management of Candidiasis in Critically Ill Patients

College of Pharmacy, University of New Mexico at Albuquerque

Larry H. Danziger, PharmD

Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago

Susan L. Pendland, PharmD

Department of Pharmacy Practice (MC 886), College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Room 164, Chicago, IL 60612-7230, pendland{at}uic.edu

Fungal infections have been increasing at an alarming rate in critically ill patients. Candida is now the fourth most common pathogen isolated from the bloodstream and is associated with significant morbidity, mortality, and economic consequences. Novel antifungals have been developed in recent years to provide alternatives to amphotericin B, which continues to be the standard therapy for most invasive fungal infections. These alternatives include lipid-based amphotericin B, ketoconazole, fluconazole, itraconazole, caspofungin, and potentially voriconazole. Optimal therapy for the various forms of candidiasis remains controversial. A standardized antifungal susceptibility testing method for Candida isolates has been developed to assist drug selection, but its clinical relevance remains to be determined. The relative susceptibility of Candida isolates can be estimated by the species. Specifically, C krusei is resistant to azoles, C glabrata may be resistant to azoles, and C lusitaniae may be resistant to amphotericin B Candida infections can affect any organ system, and the diagnosis of such infections remains difficult. The Infectious Diseases Society of America recently developed guidelines for the management of candidiasis. This review includes a brief discussion of systemically administered antifungal agents and provides a synopsis of the practice guidelines for the management of candidiasis.

Key Words: candidiasis • candidemia • antifungals • fungemia • treatment

Journal of Pharmacy Practice, Vol. 15, No. 2, 106-113 (2002)
DOI: 10.1106/UMB5-3HEG-23J1


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