Treatment of Candida infections of the central nervous system in adults

Treatment of Candida infections of the central nervous system in adults

Therapy
Initial therapy	Step-down therapy	Comments
Liposomal amphotericin B 5 mg/kg IV daily with or without flucytosine* 25 mg/kg orally four times daily for several weeks, followed by step-down therapy with fluconazole once the patient has responded to initial therapy.	Fluconazole 400 to 800 mg (6 to 12 mg/kg) orally^¶daily	Treat until all signs and symptoms, cerebrospinal fluid abnormalities, and radiographic abnormalities have resolved. Removal of intraventricular devices and other CNS devices is recommended.

The doses above are intended for patients with normal renal function. The doses of fluconazole and flucytosine must be adjusted in the setting of renal insufficiency. Refer to the Lexicomp monographs included within UpToDate for additional information including specific dose adjustment recommendations.

IV: intravenously; CNS: central nervous system.
* Toxic effects on bone marrow and liver require careful monitoring, preferably with frequent serum flucytosine levels.
¶ Since fluconazole is highly bioavailable, oral therapy is appropriate for most patients. Intravenous therapy (at the same 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.

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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Treatment of Candida infections of the central nervous system in adults