New guidelines for the management of candidiasis provide updated data on the appropriate use of echinocandins and expanded spectrum azoles in the management of candidemia and mucosal candidiasis.   

The guidelines recommend echinocandin for patients with moderate to severe illness or those who have had recent azole exposure. However, azoles should not be used for empirical therapy in patients who have received an azole for prophylaxis. 

Early initiation of effective antifungal therapy is crucial in the successful treatment of candidemia.  Fluconazole continues to be the standard therapy for patients with candidemia and should be considered as the first-line of treatment for mild to moderate conditions.  

Preferred treatments for osteoarticular, CNS, vulvovaginal, and urinary tract infections candidiasis were also addressed throughout the document.

The guidelines’ performance measures emphasize that all patients with candidemia should undergo dilated ophthalmological evaluation.  This process helps determine whether or not patients with endophthalmitis need surgery or local therapy.  Antifungal therapy should also be performed on all patients with candidemia within 24 hours after a positive blood culture followed by systemic antifungal therapy.  Blood cultures should be obtained daily until the condition is no longer present. 

The candidiasis guidelines are available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of IDSA's website.

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