Treatment of Candida auris Infection
Echinocandins are the recommended initial treatment for most C. auris infections in adults and children aged >2 months. [1] Amphotericin B deoxycholate is the recommended initial treatment for neonates and infants aged <2 months. [1] Treatment is recommended only for clinical infection. [1]
Medication Selection Algorithm
- Echinocandin therapy is recommended as initial therapy for adults and children aged >2 months. [1]
- Amphotericin B deoxycholate is recommended as initial therapy for neonates and infants aged <2 months. [1]
- Liposomal amphotericin B is recommended when echinocandin resistance is present or when clinical improvement does not occur after 5 days of echinocandin therapy. [1]
Key Evidence Supporting This Recommendation
- Echinocandins are recommended as initial therapy for candidemia due to Candida species with a strong recommendation and high-quality evidence in the IDSA candidiasis guideline. [2]
- C. auris clinical care guidance from CDC recommends echinocandins as initial therapy for most C. auris infections based on limited available data. [1]
Medication Dosing Recommendations
Adults and children >2 months
- Anidulafungin: 200 mg IV loading dose, then 100 mg IV daily. [1]
- Caspofungin: 70 mg IV loading dose, then 50 mg IV daily. [1]
- Micafungin: 100 mg IV daily. [1]
- Pediatric dosing adjustments for micafungin: 2 mg/kg/day IV with option to increase to 4 mg/kg/day IV in children at least 40 kg. [1]
Neonates and infants <2 months
- Amphotericin B deoxycholate: 1 mg/kg IV daily. [1]
- If unresponsive: liposomal amphotericin B 5 mg/kg IV daily. [1]
Infection Control and Supportive Management
- C. auris treatment should be paired with recommended infection control measures during and after treatment because patients generally remain colonized for long periods and perhaps indefinitely. [1]
- Consider consultation with an infectious disease specialist. [1]
- Monitor response to treatment and adjust therapy as needed. [1]
- All cases should be reported to state or local health departments. [1]
Resistance-Driven Escalation and Alternative Therapy
- Echinocandin resistance or pan-resistance is increasingly reported for C. auris. [1]
- Liposomal amphotericin B (5 mg/kg daily) should be considered when susceptibility testing indicates echinocandin resistance. [1]
- Liposomal amphotericin B (5 mg/kg daily) should be considered when patients treated with echinocandins do not improve after 5 days. [1]
- Investigational drugs may be considered for echinocandin-resistant and pan-resistant infections. [1]
Initiation Thresholds and When Not to Treat
- Antifungal treatment should not be initiated for colonization or for C. auris detected in noninvasive sites without signs or symptoms of infection. [1]
- Treatment decisions should be based on clinical infection rather than screening results. [1]
Monitoring for Clinical Response
- Clinical response should be carefully monitored during therapy with adjustment as needed. [1]
- Susceptibility testing is recommended in patients receiving antifungal therapy because echinocandin-resistant and pan-resistant cases are increasing. [1]