HOW INVASIVE CANDIDIASIS IS TREATED

A number of different agents are provided to prevent and treat invasive candidiasis. Before we go through these agents, it’s helpful to discuss the timeline of treatment for invasive candidiasis:

  • Prophylaxis is started in patients at high risk of invasive candidiasis. This might include patients with certain types of cancer, those who have received transplants, or certain people in the intensive care unit.
  • Empiric therapy is begun before diagnosis in a person with a lot of invasive candidiasis risk factors who has symptoms, such as fever, suggesting an infection.
  • Pre-emptive therapy is similar to empiric therapy, but the patient has a positive (but not definitive) test suggesting invasive candidiasis (for example, a positive Beta-D-Glucan test).
  • Targeted therapy is begun after diagnostic testing has established invasive candidiasis.

Communication Tip:

Start Early but Keep Testing!

With invasive candidiasis, early treatment is important. Treatment started early decreases mortality. Therefore, your healthcare provider may use prophylactic, empiric, or pre-emptive therapy when managing invasive candidiasis. But how do they know they are giving the correct drug without a proper diagnosis? Providers need to keep doing diagnostic testing, often with antifungal susceptibility, to establish the type of infection and select the best therapy. Advocate for yourself or your loved one to make sure treatment is started as soon as possible and that diagnostic testing continues until the correct targeted treatment is given.

Types of therapy available for the management of invasive candidiasis

Below is a list of the classes of agents used to manage invasive candidiasis as well as specific therapies. Some of these agents are approved by the US Food and Drug Administration (US FDA) for management of invasive candidiasis, while others are not FDA approved but recommended by the Infectious Diseases Society of America in their candidiasis guidelines.

Echinocandins are medications given by vein that work by inhibiting the synthesis of part of the fungal cell wall. These drugs are powerful and are generally the preferred drugs for treating most cases of invasive candidiasis. They include anidulafungin (ERAXIS®), caspofungin (CANCIDAS®), and micafungin (MYCAMINE®), which are given once daily, and rezafungin (REZZAYO®), which is given once weekly.

Triazoles (also known as azoles) are named by their chemical structure and are given by mouth or IV. Fluconazole (DIFLUCAN®) is an alternative to an echinocandin that is recommended for invasive candidiasis in patients who are not critically ill or are not likely to have fluconazole-resistant species. Other azoles that may be used in invasive candidiasis include isavuconazonium sulfate (CRESEMBA®), Itraconazole (SPORANOX®, ONMEL®, suba-itraconazole, TOLSURA®), posaconazole (NOXAFIL®), and voriconazole (VFEND®).

Polyenes are derivatives of amphotericin B. These drugs are currently only given by IV and they are recommended for patients with Candida that is resistant or who can’t tolerate azoles or echinocandins. Polyenes include amphotericin B deoxycholate (conventional amphotericin, FUNGIZONE®), amphotericin B lipid complex (ABELCET®), and liposomal amphotericin B (AMBISOME®).

Antimetabolites are drugs that interfere with the energy production of cells. Flucytosine (ANCOBON®) is an antimetabolite sometimes used as part of combination therapy for invasive candidiasis.

There are also treatments available in clinical trials. To learn more about clinical trials, see MyCARE’s clinical trial matching service available in conjunction with Carebox Connect.