Abstract
The treatment of candidiasis has evolved significantly over the past decade. The recognition of the influence of invasive Candida infections on morbidity and mortality, an abundance of recent in vitro and clinical data, and the availability of new antifungal agents with significant activity versus most Candida spp. have had a major influence on the therapeutic approach to this increasingly common disorder. Because of many significant changes in therapy since the publication of the last IDSA Candidiasis Treatment Guidelines in 2004, a revised version has recently been accepted by IDSA for publication in the near future. The most significant changes in these new guidelines relate to the importance of the echinocandins as a primary therapy for many forms of invasive candidiasis. For example, an echinocandin is favored for patients with proven or suspected candidemia among patients who are moderately to severely ill; de-escalation to fluconazole, when appropriate, is favored among patients who are culture-negative and improving clinically. The new guidelines emphasize the use of echinocandins for candidemia due to C. glabrata, and favor fluconazole or amphotericin B for infections due to C. parapsilosis. In neonates, fluconazole is favored for most Candida infections, but growing experience with the echinocandins suggests an important role for these agents in this population. For less common conditions such as endocarditis, hepatosplenic candidiasis, osteomyelitis, endophthalmitis, and central nervous system candidiasis, there have been few changes changed with regard to new therapies due to little or no new treatment data. The role of voriconazole for treatment of candidiasis is very limited due to the lack of significant benefit over fluconazole.
