Therapeutic approaches in patients with candidemia. Evaluation in a multicenter, prospective, observational study.
OBJECTIVE
To evaluate the morbidity and mortality of Candida fungemia and to assess the efficacy of low- vs high-dose amphotericin B and fluconazole vs amphotericin B in patients with candidemia.


METHODS
Multicenter, prospective, observational study of 427 consecutive patients with candidemia.


RESULTS
The mortality rate for patients with candidemia was 34%. The mortality rate for patients with catheter-related candidemia in whom the catheters were retained was significantly higher than that of patients in whom the catheters were removed (41% vs 21%, P < .001). We found no overall difference in mortality in patients treated with low-dose (total amphotericin B dose of < or = 500 mg) (13%) vs high-dose amphotericin B (total amphotericin B dose of > 500 mg) (15%), but the group treated with a low dose had fewer side effects (40%) than those treated with a high dose (55%) (P = .03). Fluconazole was as efficacious as amphotericin B in the therapy of candidemia, even when stratified by risk factors for mortality. Fewer side effects were seen with fluconazole (12%) compared with amphotericin B (44%) (P < .001).


CONCLUSIONS
In selected patients with candidemia, low-dose amphotericin B was as efficacious as high-dose amphotericin B. Based on other studies and ours, fluconazole seems to be an alternative therapeutic option to amphotericin B in selected patients.
Nguyen
M H
MH
Department of Medicine, University of Pittsburgh, PA, USA.
Peacock
J E
JE
Tanner
D C
DC
Morris
A J
AJ
Nguyen
M L
ML
Snydman
D R
DR
Wagener
M M
MM
Yu
V L
VL
D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects; D015725:Fluconazole / Q000627:therapeutic use*; D016469:Fungemia / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole