TABLE 6.

Recommendations for the prophylaxis and treatment of candidemia/invasive candidiasis (C/IC) in neutropenic patients

Therapeutic strategy	Antifungal therapeutic options
	Preferred	Second line
Prophylactic therapy
Low-risk patients (neutropenia <7 days)	Not recommended (A-III)	NA
Acute leukemia (remission induction) and allogeneic HSCT	Intravenous (IV)/oral fluconazole 400 mg/day (A-I)	Oral itraconazole 200 mg/twice a day (B-I); or oral posaconazole 200 mg/three times a day (A-I); or IV caspofungin 50 mg/day (acute leukemia [B-III]); or IV micafungin 50 mg/day (allogeneic HSCT [B-I])
Acute leukemia (postremission consolidation) or HGF-supported autologous HSCT	Not recommended (B-II)	NA
Pre-emptive therapy	Not recommended – insufficient data (C-III)	NA
Empirical therapy	IV LFAmB 3 mg/kg/day (A-I); or caspofungin 70 mg on day 1, then IV 50 mg daily (A-I); or IV AmB-d 0.6 mg/kg/day to 1.0 mg/kg/day (B-II in the absence of risk factors for nephrotoxicity)	Fluconazole 800 mg or IV/oral 400 mg/day (for less severely ill patients [B-II]); or voriconazole 6 mg/kg every 12 h for 24 h, then IV doses of 4 mg/kg every 12 h or oral doses of 200 mg twice daily (if risk of mould infection present) (B-I)
Therapy for microbiologically or histologically documented C/IC	IV AmB-d 0.6 mg/kg/day to 1.0 mg/kg/day (A-I); or IV LFAmB 3 mg/kg/day (A-I); or IV ECH (IV anidulafungin 200 mg → 100 mg daily [B-III]; or IV caspofungin 70 mg → 50 mg daily [A-I]; or IV micafungin 100 mg daily [B-III])	Fluconazole 800 mg or IV/oral 400 mg/day daily (for less severely ill patients [A-II]); or IV voriconazole 6 mg/kg every 12 h for 24 h then 4 mg/kg every 12 h or oral doses of 200 mg twice daily (if risk of mould infection is present) (B-I)

AmB-d Amphotericin B deoxycholate; LFAmB Lipid formulation amphotericin B; ECH Echinocandin; HGF Hematopoietic growth factor; HSCT Hematopoietic stem cell transplant; NA Not applicable