Fungal endocarditis

Management

• 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