1. Antimicrobial treatment for Systemic Candidiasis

2. Systemic Candidiasis 2 primary syndromes: 1. Candidemia 2. Disseminated candidiasis

3. Candidemia - associated with several days of fever unresponsive to antimicrobials, prolonged IV catheterization, multi organ infection -others: intravascular catheter-related candidiasis, suppurative thrombophlebitis, endocarditis

4. Disseminated candidiasis -frequently associated with multiple deep organ infections or may involve single organ infection. - Candida osteomyelitis, arthritis, endocarditis, pericarditis, and meningitis, requires prolonged antifungal therapy for at least 4-6 weeks. - The history of a patient with presumptive disseminated candidiasis reveals a fever unresponsive to broad-spectrum antimicrobials and negative results from blood culture. - Physical examination reveals fever (may be the only symptom) with an unknown source and associated sepsis and septic shock.

5. Antimicrobial agents DRUGINDICATIONREMARKS Azole - Fluconazole (IV/oral) - drug of choice in most cases of candidemia and disseminated candidiasis. (in non- neutropenic and hemodynamicaly stable patients - lower nephrotoxicity rates (<2%) and ease of use because of the high degree of bioavailability and the long half-life of the drug - Voriconazole (IV/Oral) - If additional mold coverage is desired - used in neutropenic and hemodynamicaly unstable patients Echinocandins (Capsofungin IV) -recommended for candidemia in most patients with neutropenia. -Caspofungin is a broad- spectrum - It is an effective alternative for severe mucosal infections and systemic infections due to Candida, especially those due to non-albicans Candida species

6. -recommended for candidemia in most patients with neutropenia.- Caspofungin is a broad-spectrum semisynthetic echinocandin. It is an effective alternative for severe mucosal infections and systemic infections due to Candida, especially those due to non- albicans Candida species such as C glabrata. - It is an effective alternative for severe mucosal infections and systemic infections due to Candida, especially those due to non-albicans Candida species such as C glabrata.- can be initiated as a 70-mg loading dose, followed by 50 mg/d intravenously to complete a minimum of 2 weeks of antifungals after improvement and after blood cultures have cleared. Anudilafungin IV - Anidulafungin is a broad- spectrum echinocandin. It is an effective alternative for severe mucosal infections and systemic infections due to candida - be initiated as a 200-mg loading dose, followed by 100 mg intravenously to complete a minimum of 2 weeks of antifungals after improvement and after blood cultures have cleared. Micafungin IV It has been shown to be an effective alternative for severe mucosal infections and systemic infections due to Candida, especially those due to non- albicans Candida species - administered at 100 mg/d intravenously to complete a minimum of 2 weeks of antifungals after improvement and after blood cultures have cleared.