Treatment

Six antifungals (amphotericin B, fluconazole, voriconazole, caspofungin, micafungin, and anidulafungin) have been studied as montherapy in prospective, randomized comparative clinical trials for the treatment of invasive candidiasis.19,23-27 While these treatment options are considered to have relatively equivalent efficacy, they differ somewhat in toxicity and associated drug-drug interaction profiles. Lipid amphoteri-cin B formulations are probably as effective as the aforementioned agents; however, evidence supporting their use is derived principally from open-label observational studies and empiric therapy trials of febrile neutropenia.19 Moreover, the acquisition cost of lipid amphotericin B formulations is relatively higher compared to fluconazole and the echinocandins. As a result, their first-line use is not prominently recommended in evidence-based guidelines for proven infection.20 No prospective randomized, controlled clinical trials have been published comparing antifungal therapies for proven acute disseminated candidiasis in neutropenic patients, chronic disseminated candidiasis, or other forms of deep-organ candidiasis. 9

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