Candidemia: Treatment, Procedure, Cost and Side Effects

Candida is known as the root of nosocomial bloodstream infections. Candida is not restricted to abdominal surgery wards, intensive care units or hematological patients, but is remarkably common in the internal medical setting. High mortality can be decreased by prompt, proper antifungal therapy, in association with candidemia. In case of species, the epidemiology has been seen to move towards non-albicans strains. Treatment guidelines put emphasis on echinocandins as the best choice for people who are perhaps infected with fluconazole-resistant strains or severely ill. The yeast known as candida is responsible for a large number of humans getting affected by systematic invasive infections. The incidence of systematic candidemia has increased significantly over the years.

There are 3 types of treatment available for candidemia. The first treatment is prophylaxis which is mostly based on the incidence of IC. Prophylaxis may be examined appropriate in certain patients who are at a high risk of this infection, while patients with low incidence rate may benefit from pre-emptive therapies based on serological assays, formal predictive scores, risk factors and clinical presentations. The second one is empirical treatment method which is defined as the administration of fungus in presence of refractory or persistent fever in patients who are at a risk of developing invasive fungal infection. Thirdly, pre-emptive treatment method is the known as the start of an antifungal therapy when one or more clinical makers or microbiological results turn positive.

Early diagnosis along with rapid appropriate treatment is considered the cornerstone of successfully managing the reduction of mortality rate in association with candidemia. Prophylaxis treatment includes oral fluconazole as the superior or effective as compared to topical therapy for candidemia. Oral therapy is considered better tolerated and more convenient than topical therapy. In addition, oral therapy is more efficacious than topical regimens in treating esophageal candidiasis. Oral fluconazole (100 mg/day) is considered the best drug to treat oropharyngeal candidiasis.

The usage of topical agents for the treatment of oropharyngeal candidiasis diminishes systematic drug exposure, lowers the risk of drug-drug amalgamation, reduces the likelihood that antifungal resistance may develop, and systemizes adverse events. Multiple daily dosing and unfavourable taste in case of nystatin and clotrimazole leads to reduced endurance of topical therapy. An alternative to fluconazole is miconazole in mucoadhesive buccal tablets (50 mg/day) or clotrimazole troches 5 times daily may be used for the treatment of oropharyngeal candidiasis. According to a multicenter, randomized study, these regimens were equivalent to fluconazole. Pastilles (4 times daily) or nystatin suspension remains till date as an additional alternative. An effective treatment for esophageal candidiasis is systematic antifungals. A 14-21 day course of either oral intraconazole or intravenous or oral fluconazole solution is considered highly effective.

The eligibility criteria depends on the CD4 count. If the CD4 count is 200 cells or lower, the person is eligible for the treatment. The treatment is started as soon as the patient starts showing signs related to the disease.

In case of co-existing conditions patients are excluded. These include evidence of chronic or acute candidemia. Severe or moderate liver disease is also a criteria of non-eligibility. History of intolerance or allergy to azoles or imidazoles excludes you from receiving the treatment.

Side effects of the treatment include vomiting, nausea, abdominal pain, transaminase elevations, diarrhea, and hypertensive reactions like pruritus and rash.

In case of patients with mucocutaneous candidiasis, retaliation to antifungal therapy is rapid; symptoms usually improve in 48 to 72 hrs. Liver functions, especially in patients with hepatic comorbidities, must be monitored periodically in case azole therapy is carried out for more than 21 days. In renal failure, no dose adjustments are required. The post treatment guidelines are recommendations by doctors to carry out proper management by preventing and controlling the outbreaks. Hospital based infection control programs are there to help lessen the chances of relapse. Antibiotic stewardship is the most recommended method to reduce the risk factors. Patients must be monitored for symptoms of carbolic state or malnutrition. If indicated, parenteral or eternal electrolytes, lipids, carbohydrates, proteins and vitamins, and amino acids should be supplemented. A proper diet chart must be made.

It usually takes maximum 21 days to recover.

The price of treatment ranges between Rs. 1,000 to Rs. 10,000.

The results of the treatment is not permanent, hence fluconazole is used as a suppressive therapy in such cases. Relapse rate in patients with esophageal candidiasis or azole-refractory candidiasis is usually quite high.

The alternative treatment methods for candidemia is the intake of garlic, food items made from coconut oil, food items made from oregano oil, yogurt, apple cider vinegar.