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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Treatment of Candida osteoarticular infections in adults

Treatment of Candida osteoarticular infections in adults
Condition or treatment group Therapy
Primary Alternative Comments
Osteomyelitis

Fluconazole 400 mg (6 mg/kg) orally* daily for 6 to 12 months

OR

An echinocandin (1 of the following, for at least 2 weeks):

  • Caspofungin 70 mg IV  (loading dose), followed by 50 to 70 mg daily
  • Micafungin 100 mg IV daily
  • Anidulafungin 200 mg IV (loading dose), followed by 100 mg IV daily

Followed by fluconazole 400 mg (6 mg/kg) orally daily for 6 to 12 months

 Lipid formulation of amphotericin B 3 to 5 mg/kg IV daily (for at least 2 weeks), followed by fluconazole 400 mg (6 mg/kg) orally daily (for 6 to 12 months) Duration of therapy is prolonged (6 to 12 months). Surgical debridement is frequently necessary.
Septic arthritis

Fluconazole 400 mg (6 mg/kg) orally* daily for 6 weeks

OR

An echinocandin (1 of the following, for 2 weeks):

  • Caspofungin 70 mg IV (loading dose), followed by 50 to 70 mg IV daily
  • Micafungin 100 mg IV daily
  • Anidulafungin 200 mg IV (loading dose), followed by 100 mg IV daily

Followed by fluconazole 400 mg (6 mg/kg) orally daily for at least 4 weeks

 Lipid formulation of amphotericin B 3 to 5 mg/kg IV daily (for at least 2 weeks), followed by fluconazole 400 mg (6 mg/kg) orally daily (for at least 4 weeks) Duration of therapy is usually for at least 6 weeks, but few data are available. Surgical drainage is recommended for all cases. For infected prosthetic joints, removal is recommended for most cases. If the prosthetic device cannot be removed, chronic suppression with fluconazole 400 mg (6 mg/kg) orally daily should be given if the isolate is susceptible.
The fluconazole dose requires adjustment in renal insufficiency (CrCl ≤50 mL/minute); the caspofungin dose requires adjustment in moderate or severe hepatic impairment. Refer to the Lexicomp monographs included within UpToDate for additional information including specific dose adjustment recommendations.
IV: intravenously.
​* Since fluconazole is highly bioavailable, oral therapy is appropriate for most patients. IV therapy with an echinocandin or fluconazole (at the same dose as the oral dose) should be given to patients who are unable to take oral medications, who are not expected to have good gastrointestinal absorption, or who are severely ill. Patients treated initially with IV fluconazole should be transitioned to oral fluconazole when feasible.
Data from: Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.
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