S52(4) Oral and esophageal candida

Question 1

“cottage cheese” appearance
Yellowish white
Soft plaques overlying areas of erythema on the buccal mucosa, tongue, gums, and throat

Answer 1

Oropharyngeal Candidiasis (Thrush)

Diagnosed on appearance

Question 2

Treatment of mild Oropharyngeal Candidiasis (Thrush)

Answer 2

• Clotrimazole troches 10mg 5 times daily x 7-10 days OR
• Miconazole mucoadhesive buccal 50mg tablet applied to the mucosal surface one daily x 7-10 days

can see:
Nystatin suspension 100,000 U/mL 4-6mL 4 times daily x 7-14 days OR
1-2 nystatin pastilles (200,000 U each) 4 times daily x 7-14 days

Question 3

Treatment of moderate to severe Oropharyngeal Candidiasis (Thrush)

Answer 3

Fluconazole 100-200mg daily x 7-14 days

Question 4

Esophageal Candidiasis Requires systemic antifungal therapy

Answer 4

Fluconazole 200-400mg (3-6mg/kg) PO daily x 14-21 days

Question 5

Esophageal Candidiasis Requires systemic antifungal therapy if NOT able to take PO

Answer 5

Fluconazole 400mg (6mg/kg) IV daily
Echinocandin but different doses
Micafungin 150mg IV daily
Caspofungin 70mg LD then 50mg IV daily
Anidulafungin 200mg IV daily

Question 6

Risk Factors for Invasive Fungal Infections (IFI)

General

Answer 6

Neutropenia (ANC < 500/mm3)
AIDS
Immunosuppressive therapy

Question 7

Risk Factors for Invasive Fungal Infections (IFI)

Candida Specific

Answer 7

Exposure to broad spectrum antibiotics
Recent major surgery (especially abdominal surgery)
Parenteral nutrition
Central venous catheters

Question 8

Candidemia (candida in the blood)

empiric therapy

Answer 8

micafungin

Question 9

Candidemia (candida in the blood)

definitive therapy

Answer 9

alibicans
Fluconazole 12mg/kg load then 6 mg/kg daily

Voriconazole 6mg/kg twice daily x 2 doses then 3 mg/kg twice daily
For step down therapy resistant to fluconazole

Question 10

Candidemia (candida in the blood) duration of therapy

Answer 10

2 weeks from first negative culture

Question 11

Candida endocarditis empiric therapy

Answer 11

amphotericin B
Main therapy source control
prostetic vlve replacement

Question 12

Intra-abdominal Candidiasis

Answer 12

Source control!!!

Empiric: Echinocandin
Micafungin 100mg daily
Caspofungin 70mg LD then 50mg daily
Andiulafungin 200mg LD then 100mg daily

Question 13

Oropharyngeal Candidiasis

First Line Empiric

Answer 13

Mild: Clotrimazole or Miconazole

Mod-Severe: Fluc

Question 14

Esophageal Candidiasis

First Line Empiric

Answer 14

Fluconazole

Question 15

Candidemia

First Line Empiric

Answer 15

Echinocandin
Micafungin 100mg daily
Caspofungin 70mg LD then 50mg daily
Andiulafungin 200mg LD then 100mg daily

Question 16

Candida IEC

First Line Empiric

Answer 16

AmB +/- Flucytosine then Fluc

Question 17

Intra-abdominal Candidiasis

First Line Empiric

Answer 17

Source control

Echinocandin

Question 18

Definitive treatment of
C. albicans
C. tropicalis
C. parapsilosis

Answer 18

Fluconzole

Question 19

Definitive treatment of
C. glabrata
C. krusei

Answer 19

Echinocandin
Micafungin 100mg daily
Caspofungin 70mg LD then 50mg daily
Andiulafungin 200mg LD then 100mg daily