Fungal endocarditis: Difference between revisions
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== Background == |
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* Most commonly caused by yeast within the genus [[Candida]], though many species of [[Candida]] are now being reclassified into distinct genera |
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== Management == |
== Management == |
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=== Yeast-Related Endocarditis === |
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* Initial treatment with [[Is treated by::liposomal amphotericin B]] 3-5 mg/kg IV daily, ± [[Is treated by::flucytosine]] 25 mg/kg PO qid |
* Initial treatment with [[Is treated by::liposomal amphotericin B]] 3-5 mg/kg IV daily, ± [[Is treated by::flucytosine]] 25 mg/kg PO qid |
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** 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) |
** 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) |
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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
