A 60-year-old diabetic patient on broad-spectrum antibiotics for 2 weeks develops oral thrush and then systemic candida fungaemia. Blood cultures grow yeast. The MOST appropriate antifungal for non-critically ill patients without prior azole exposure, according to current guidelines, is:
- A Fluconazole 400 mg IV/oral daily
- B Voriconazole 6 mg/kg IV every 12 hours
- C Amphotericin B deoxycholate IV
- D An echinocandin (caspofungin/micafungin/anidulafungin) IV ✓
Explanation
Current IDSA 2016 and ESCMID guidelines recommend an echinocandin (caspofungin, micafungin, or anidulafungin) as first-line treatment for candidaemia/invasive candidiasis, regardless of azole exposure history, because of their superior safety profile, low resistance rates across Candida species including C. glabrata and C. krusei, and comparable efficacy to fluconazole. Fluconazole is an acceptable alternative only in stable, non-critically ill patients with susceptible species and no prior azole exposure. Amphotericin B is now reserved for resistant or refractory infections due to its nephrotoxicity.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.