Initiation of Empirical Fluconazole or Micafungin for Managing Candidemia?

In a retrospective cohort study of immunocompromised and severely ill patients with candidemia, illness severity — not initial selection of empirical antifungal therapy — determined clinical outcomes.

Due to escalating azole-resistant Candida strains, guidelines of the Infectious Disease Society of America (IDSA) recommend first-line echinocandins for candidiasis in critically ill patients; however, despite demonstrable in vitro activity, echinocandin use has not yet translated into improved outcomes (e.g., reduced mortality). Theodore and colleagues performed a retrospective cohort study of 197 patients at two U.S. hospitals who were immunocompromised or who were admitted to the intensive care unit (ICU) for candidemia. Participants had received at least 3 days of initial therapy with fluconazole or micafungin. Complete response (the primary outcome, a composite of clinical improvement and blood-culture sterilization) as well as surviva…

Reviewing Author

George Sakoulas, MD

Disclosures

Consultant/Advisory BoardParatek Pharmaceuticals; Nestle Corp.; AbbVie; Shionogi

Speaker’s BureauAllergan/AbbVie; Paratek Pharmaceuticals; Nestle Corp.

RoyaltiesUpToDate

Editorial BoardsAntimicrobial Agents and Chemotherapy; Open Forum Infectious Diseases

George Sakoulas, MD

Disclosures

Consultant/Advisory BoardParatek Pharmaceuticals; Nestle Corp.; AbbVie; Shionogi

Speaker’s BureauAllergan/AbbVie; Paratek Pharmaceuticals; Nestle Corp.

RoyaltiesUpToDate

Editorial BoardsAntimicrobial Agents and Chemotherapy; Open Forum Infectious Diseases

Initiation of Empirical Fluconazole or Micafungin for Managing Candidemia?

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Reviewing Author