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December 11, 1995

Therapeutic Approaches in Patients With Candidemia: Evaluation in a Multicenter, Prospective, Observational Study

Author Affiliations

From the Departments of Medicine, University of Pittsburgh and Veterans Affairs Medical Center, Pittsburgh, Pa (Drs M. H. Nguyen, M. L. Nguyen, and Yu, and Ms Wagener); Bowman-Gray School of Medicine, Winston-Salem, NC (Dr Peacock); Duke University Medical Center, Durham, NC (Drs Tanner and Morris); New England Medical Center (Tufts University), Boston, Mass (Dr Snydman).

Arch Intern Med. 1995;155(22):2429-2435. doi:10.1001/archinte.1995.00430220087009

Objectives:  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 ≤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.(Arch Intern Med. 1995;155:2429-2435)