Patient handout

Candidemia / invasive candidiasis

PRODUCTION

1. Your condition

This handout is for candidemia / invasive candidiasis. Your care team identified this based on: blood culture growing yeast (idsa 2024).

Other reasons your team may use this plan: beta-d-glucan elevated in high-risk patient (idsa 2024); persistent fever on broad-spectrum antibiotics (idsa 2024); central line in patient with risk factors (tpn, abx, icu) (idsa 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
caspofungin	70 mg IV load × 1 then 50 mg IV daily	IV	daily	IDSA 2016 strong — first-line for non-neutropenic and neutropenic adults; covers most species including azole-resistant C. glabrata and C. krusei
micafungin	100 mg IV daily	IV	daily	IDSA 2016 alternative echinocandin — equivalent efficacy
anidulafungin	200 mg IV load × 1 then 100 mg IV daily	IV	daily	IDSA 2016 alternative echinocandin
fluconazole	800 mg (12 mg/kg) IV/PO load × 1 then 400 mg (6 mg/kg) daily	IV/PO	daily	IDSA 2016 — step-down once stable + susceptible isolate identified; PO has full bioavailability
liposomal_amphotericin_B	3-5 mg/kg IV daily	IV	daily	IDSA 2016 — for refractory disease, deep-seated infection, or pregnancy; nephrotoxicity monitoring
voriconazole	6 mg/kg IV q12h × 2 then 3-4 mg/kg q12h	IV/PO	q12h	IDSA 2016 — additional CNS / ocular penetration option

Plan: Candidemia / invasive candidiasis — echinocandin-first per IDSA 2016

3. When to call your provider

Contact your care team if any of the following happen:

New fever / chills / rigors during OPAT → return to ED for recurrent candidemia workup + cultures + line evaluation (IDSA 2016 Pappas)
New ophthalmologic complaint (eye pain, decreased vision, floaters) → emergent ophthalmology + dilated funduscopy (IDSA 2016 Pappas)
New cardiac symptoms (new murmur, dyspnea, embolic phenomena) → TEE + ID consult; consider endocarditis (IDSA 2016 Pappas; AHA endocarditis 2015)
Azole hepatotoxicity (AST/ALT > 5× ULN) → hold azole + switch to echinocandin or L-AmB; hepatology consult if severe (DailyMed labels)
L-AmB nephrotoxicity (creatinine ≥ 1.5× baseline) → reduce dose / extend interval / switch to echinocandin if species permits (IDSA 2016 Pappas)
Drug-interaction event (INR > 5, tacrolimus trough > 15, rhabdomyolysis on statin) → adjust per DDI rules + safety consult (DailyMed labels)
Line dysfunction / line-site infection → IR or vascular consult; consider line removal + alternative access (Mermel IDSA CRBSI 2009)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Non-tunneled central venous catheter still in place 48 h after first positive Candida blood culture (IDSA 2024)
Blood cultures still positive 5 days after appropriate echinocandin + line management (IDSA 2024)
Hypotension on adequate fluids + lactate >2 + Candida bloodstream infection (IDSA 2024)(life-threatening)
ANC <500 + candidemia (IDSA 2024)
Candida auris on culture (high MDR risk) (IDSA 2024)
Chorioretinitis or endophthalmitis on dilated fundus exam (IDSA 2024)

5. Follow-up

ID outpatient follow-up; species-stewardship feedback; antifungal taper plan (IDSA 2024)

6. Sources

Guideline: IDSA 2016 Clinical Practice Guideline for the Management of Candidiasis (Pappas et al, CID 2016) + Mermel IDSA 2009 CRBSI (central-line management) — pending IDSA / ESCMID 2024-2025 update on candidemia and C. auris