Initial therapy for candidaemia in adults
If initial echinocandin therapy is indicated for candidaemia in adults, anidulafungin, caspofungin or micafungin can be used. The choice of echinocandin may be influenced by the cost of the drug as well as patient factors. Anidulafungin is not hepatically metabolised and may be preferred in patients with severe liver impairment; micafungin or caspofungin may be preferred if the suspected source of infection is the urinary tractDomingos, 2022Gabardi, 2016Kane, 2016Rkieh, 2022Sobel, 2007. In adults with obesity, critical illness or low serum albumin, echinocandin pharmacokinetics may be altered; in these individuals, higher doses may be required to ensure adequate drug exposure, and are included below where relevant.
In adults with candidaemia, if initial echinocandin therapy is indicated, useKeighley, 2021:
1anidulafungin intravenously; see advice on continuation therapy for candidaemia and duration of therapy for candidaemia anidulafungin anidulafungin anidulafungin
adults with obesity1 with or without critical illness: 300 mg for the first dose, then 150 mg, daily
adults who are critically ill: 200 mg for the first dose, then 150 mg daily2
adults who are not critically ill: 200 mg for the first dose, then 100 mg daily
OR
1caspofungin intravenously; see advice on continuation therapy for candidaemia and duration of therapy for candidaemia caspofungin caspofungin caspofungin
adult more than 80 kg: 70 mg daily
adult 80 kg or less: 70 mg for the first dose, then 50 mg daily. For critically ill patients, a maintenance dose of 70 mg can be used
OR
1micafungin intravenously; see advice on continuation therapy for candidaemia and duration of therapy for candidaemia micafungin micafungin micafungin
adult more than 75 kg: 150 mg daily3 4
adult 75 kg or less: 100 mg daily4.
Initial fluconazole therapy may be an alternative to an echinocandin in noncritically ill adults – seek expert advice from an infectious diseases physician or clinical microbiologist.
A lipid formulation of amphotericin B is an alternative if there is resistance or intolerance to other antifungals – seek expert advice.