Spellberg et al developed an algorithm for empirical antifungal therapy in a patient with known or suspected disseminated Candidiasis. The authors are from the University of California Los Angeles Medical Center.

If the patient is (neutropenic) OR (hemodynamically unstable) OR (probably infected with Candida glabrata or Candida krusei), then:

(1) avoid the use of fluconazole

(2) use a polyene, echinocandin, or voriconazole



• A person is probably infected with C. glabrata or C. krusei if (a) colonized with either OR (b) the patient was recently exposed to fluconazole.

• It is important to cover a broad spectrum of organisms if the patient is hemodynamically unstable.

• Fluconazole should be avoided if there is a good chance that the organism is azole resistant. A static agent like fluconazole probably should not be used in a neutropenic patient.


If the patient is:

(1) not neutropenic

(2) hemodynamically stable

(3) probably not infected with Candida glabrata or Candida krusei

then use fluconazole as the first choice.

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