A Pilot Study of the Management of Uncomplicated Candidemia with a Standardized Protocol of Amphotericin B

• Published in: Clinical infectious diseases 1999-12, Vol.29 (6), p.1545-1550
• Main Authors: Fichtenbaum, Carl J., German, Matthew, Dunagan, W. Claiborne, Fraser, Victoria J., Medoff, Gerald, Diego, Jorge, Powderly, William G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Amphotericin B - adverse effects; Amphotericin B - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal agents; Antifungal Agents - adverse effects; Antifungal Agents - therapeutic use; Antifungals; Biological and medical sciences; Blood; Candida - drug effects; Candida - isolation & purification; Candidemia; Candidiasis - drug therapy; Candidiasis - mortality; Catheters; Chest Pain - chemically induced; Clinical Articles; Cultural groups; Dosage; Female; Health outcomes; Heart Failure - chemically induced; Humans; Hypertension - chemically induced; Infections; Male; Medical sciences; Middle Aged; Mortality; Pharmacology. Drug treatments; Pilot Projects; Recurrence; Relapse; Survival Rate; Time Factors; Treatment Outcome
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/313499

We evaluated an amphotericin treatment strategy on the basis of duration of candidemia and clinical findings. Patients without neutropenia who had uncomplicated candidemia received 200 mg of amphotericin B over 5–7 days if they had had ≤1 day of documented positive blood cultures (SC group) or a total of 500 mg of amphotericin B over 14–20 days if they had had >1 day of positive cultures (PC group). The clinical cure rate was 93% (95% confidence interval [CI], 77%–99%; n=29 episodes) in the SC group, with no relapses (median follow-up, 272 days). The clinical cure rate was 83% (95% CI, 64%–94%; n=29 episodes) in the PC group, with 1 relapse (4.2%). The results of this pilot study suggest that patients with candidemia may be stratified into risk groups on the basis of the duration of positive blood cultures and other clinical findings. Decisions about the duration of therapy can be made 4–7 days after initiation of treatment. Carefully selected patients with transient uncomplicated candidemia may be safely treated with a short course of amphotericin B. Further prospective validation of this concept should be undertaken particularly to evaluate the impact on low-frequency late complications (e.g., endophthalmitis).