[Therapy of systemic candidiasis]

Candida septicaemia is an increasingly common problem. Candida Albicans may be found in yeast form in the intestinal tract, vagina, skin and mucous membranes of apparently healthy individuals. The organism is ubiquitous, and systemic disease occurs almost exclusively in individuals whose resistance to infections is impaired. Diagnosis of invasive candidiasis is often delayed because of the high rate of false negative results on blood cultures, the lengthy period of time required for the identification of positive cultures and the aspecificity of positive findings on blood cultures. The most effective treatment is a combination of amphotericin B and 5-flucytosine. Treatment must be prolonged for 7 days after the first negative culture. Amphotericin B must be administered in doses of 0.5-1 mg/kg/day. Meningitis requires the intrathecal injection of amphotericin B in doses of 0.1 mg/kg/day. Amphotericin B does not induce resistance, and it is highly nephrotoxic, so that blood urea, electrolytes, serum creatinine and platelets must be monitored. 5-flucytosine is not very toxic it does induce resistance after prolonged use. The dose is 100-200 mg/kg/day given orally at 6-hour intervals.