Algorithm of Spellberg et al for Modifying Antifungal Therapy in a Patient with Disseminated Candidiasis

Description

Spellberg et al developed an algorithm for modifying antifungal therapy in a patient being treated for disseminated Candidiasis. The authors are from the University of California Los Angeles Medical Center.

Parameters:

(1) species of Candida involved

(2) empiric antifungal agent

(3) response

Species	Drug Therapy	Response	Therapy
C. albicans	fluconazole	good	continue fluconazole
	fluconazole	bad	perform susceptibility testing; look for causes for poor response; change therapy
	not fluconazole	good	consider change to fluconazole
	not fluconazole	bad	perform susceptibility testing; look for causes for poor response; change therapy
C. glabrata	fluconazole	good	continue fluconazole
	fluconazole	bad	perform susceptibility testing; change to echinocandin or high dose polyene
	not fluconazole	good	continue current therapy
	not fluconazole	bad	perform susceptibility testing; change to echinocandin or high dose polyene
C. krusei	fluconazole	good	change to echinocandin, high dose polyene or voriconazole
	fluconazole	bad	change to echinocandin, high dose polyene or voriconazole
	not fluconazole	good	continue current therapy
	not fluconazole	bad	perform susceptibility testing; change to echinocandin or high dose polyene
C. lusitaniae	fluconazole	good	continue fluconazole
	fluconazole	bad	perform susceptibility testing; look for cause for poor response; change therapy to echinocandin
	not fluconazole	good	consider change to fluconazole or echinocandin
	not fluconazole	bad	perform susceptibility testing; look for causes for poor response; change therapy to an azole or echinocandin
C. parapsilosis	fluconazole	good	continue fluconazole
	fluconazole	bad	perform susceptibility testing; look for causes for poor response; change therapy; avoid echinocandin
	not fluconazole	good	consider change to fluconazole
	not fluconazole	bad	perform susceptibility testing; look for causes for poor response; change therapy
other species	fluconazole	good	continue fluconazole
	fluconazole	bad	perform susceptibility testing; look for causes for poor response; change therapy; avoid echinocandin
	not fluconazole	good	consider change to fluconazole
	not fluconazole	bad	perform susceptibility testing; look for causes for poor response; change therapy; avoid echinocandin

where:

• Therapy for a species that is not glabrata or krusei is modelled on the therapy for Candida albicans.

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Algorithm of Spellberg et al for Modifying Antifungal Therapy in a Patient with Disseminated Candidiasis

Description

Specialty