Table 2.
Antifungal classes, agents, spectrum, and dosing in the treatment of invasive candidiasis
| Drug class | ||||||||
|---|---|---|---|---|---|---|---|---|
| Amphotericin B | Echinocandins | Azoles | ||||||
| Drug | AmB deoxycholate | Liposomal AmB | Lipid complex AmB | Anidulafungin | Caspofungin | Micafungin | Fluconazole | Voriconazole |
| Common susceptibility of Candida spp. | ||||||||
| C. albicans | S | S | S to R | S | ||||
| C. glabrata | S | Sa | S-DD to R | S to R | ||||
| C. krusei | S | S | R | S | ||||
| C. lusitaniae | S to R | S | S | S | ||||
| C. parapsilosis | S | S to R | S | S | ||||
| C. tropicalis | S | S | S | S | ||||
| Available formulations | ||||||||
| IV | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Oral | ✓ | ✓ | ||||||
| Dosing for treatment of candidaemia | ||||||||
| Loading dose (first 24 h) in adults | – | – | – | 200 mg | 70 mg | – | 12 mg/kg | 6 mg/kg (12 hourly) |
| Maintenance dose in adults | 0.5–1 mg/kg | 3 mg/kg | 5 mg/kg | 100 mg | 50 mg (70 mg if >85 kg) | 100 mg | 6 mg/kg | 3 mg/kg (12 hourly) |
| Dose adjustment in renal impairment | Contraindicated | None | None | None | None | None | Reduce dose | Avoid IV formulation |
| Dose adjustment in moderate hepatic impairment | Unknown | Unknown | Unknown | None | Dose reduce | None | Reduce maintenance dose | Halve maintenance dose |
| Dose adjustment in severe hepatic impairment | Unknown | Unknown | Unknown | None | Unknown | Unknown | Unknown | Unknown |
AmB, amphotericin B; S, susceptible; S-DD, susceptible dose dependent; R, resistant.
aReports of echinocandin resistance emerging in C. glabrata (Alexander et al. 2013).