Fungal endocarditis: Difference between revisions

Latest revision as of 17:39, 11 October 2022

Background

Most commonly caused by yeast within the genus Candida, though many species of Candida are now being reclassified into distinct genera

Management

Yeast-Related Endocarditis

Initial treatment with liposomal amphotericin B 3-5 mg/kg IV daily, ± flucytosine 25 mg/kg PO qid
- Alternative: high-dose echinocandin (caspofungin 150 mg IV daily, micafungin 150 mg IV daily, or anidulafungin 200 mg IV daily)
- Antifungal therapy should continue for at least 6 weeks after surgery
Valve replacement is recommended in essentially all cases of fungal endocarditis
- In case of prosthetic valve, this should be followed by lifelong suppressive therapy
If the valve is not replaced, step-down to lifelong suppressive therapy following treatment is recommended with fluconazole 400-800 mg PO daily
- Alternative: voriconazole 200–300 mg (3–4 mg/kg) PO bid or posaconazole 300 mg PO daily

@@ Line 1: / Line 1: @@
+== Background ==
+* Most commonly caused by yeast within the genus [[Candida]], though many species of [[Candida]] are now being reclassified into distinct genera
 == Management ==
+=== Yeast-Related Endocarditis ===
 * Initial treatment with [[Is treated by::liposomal amphotericin B]] 3-5 mg/kg IV daily, ± [[Is treated by::flucytosine]] 25 mg/kg PO qid
 ** Alternative: high-dose echinocandin ([[Is treated by::caspofungin]] 150 mg IV daily, [[Is treated by::micafungin]] 150 mg IV daily, or [[Is treated by::anidulafungin]] 200 mg IV daily)
+** Antifungal therapy should continue for at least 6 weeks after surgery
-* Step-down suppressive therapy following treatment is lifelong [[Is treated by::fluconazole]] 400-800 mg PO daily
-** Alternative: [[Is treated by::voriconazole]] 200–300 mg (3–4 mg/kg) PO bid or [[Is treated by::posaconazole]] 300 mg PO daily
 * Valve replacement is recommended in essentially all cases of fungal endocarditis
+** In case of prosthetic valve, this should be followed by lifelong suppressive therapy
-* Antifungal therapy should continue for at least 6 weeks after surgery
-* In case of prosthetic valve, this should be followed by lifelong suppressive therapy
+* If the valve is not replaced, step-down to lifelong suppressive therapy following treatment is recommended with [[Is treated by::fluconazole]] 400-800 mg PO daily
+** Alternative: [[Is treated by::voriconazole]] 200–300 mg (3–4 mg/kg) PO bid or [[Is treated by::posaconazole]] 300 mg PO daily
 [[Category:Cardiac infections]]