242.4 📌 章末速蚘

242.4.0.0.1 Mucocutaneous
  • Oral thrush (HIV CD4 < 200, steroids, dentures, DM) → clotrimazole / nystatin / fluconazole
  • Esophageal (HIV CD4 < 100, AIDS-defining) → fluconazole 200-400 × 14-21 d
  • VVC (“cottage cheese”) → fluconazole 150 × 1 or topical azoles
  • Recurrent VVC → fluconazole weekly × 6 mo or ibrexafungerp (Brexafemme 2021)
242.4.0.0.2 Invasive
  • Risk: line + broad antibiotic + ICU + abdominal surgery + neutropenia + DM + TPN + dialysis
  • Treatment: echinocandin first-line (caspofungin, micafungin, anidulafungin, rezafungin 2023 weekly)
  • Step-down to fluconazole if azole-sensitive species + stable
  • C. krusei intrinsic fluconazole R → echinocandin
  • 14 days after first negative blood culture for uncomplicated candidemia
  • Source control (line removal) + ophthalmology exam within 1 week
242.4.0.0.3 Special
  • Endocarditis: AmB + flucytosine + valve replacement
  • CNS: AmB ± flucytosine
  • UTI: fluconazole (NOT echinocandin — poor urine conc)
  • Hepatosplenic disseminated post-leukemia: prolonged 3-6 mo
242.4.0.0.4 β-D-Glucan
  • Marker for invasive Candida + PJP + Aspergillus (not specific)
242.4.0.0.5 Species AST
  • C. krusei: intrinsic fluconazole R
  • C. glabrata: high fluconazole R; echinocandin preferred
  • C. parapsilosis: variable echinocandin MIC
  • C. auris: multi-drug R (Ch 252)
242.4.0.0.6 盧醫垫 hint
  • ICU + line + fever + bacterial cx neg → empirical echinocandin while awaiting Candida cultures
  • HIV CD4 < 100 + odynophagia → empirical fluconazole for esophageal candidiasis
  • Recurrent VVC + DM/pregnancy → maintenance fluconazole + DM control