Optimal duration of antifungal therapy in candidemia

In candidemia, the standard 14-day antifungal treatment after blood culture clearance has been long accepted, despite being based on limited and outdated evidence. This review discusses the rationale for re-evaluating treatment duration, in the context of growing interest in optimizing antifungal use.

A small number of retrospective studies have explored shorter treatment courses in uncomplicated candidemia, suggesting similar outcomes in terms of mortality and recurrence compared to the traditional 14-day regimen. However, these data are limited and potentially biased, with no randomized controlled trials available to provide definitive guidance. Moreover, no validated clinical, microbiological, or biomarker-based algorithms currently exist to inform individualized treatment duration in daily practice.

The historical 14-day rule for candidemia treatment is increasingly challenged by recent literature, yet the available evidence remains scarce and methodologically limited. A well designed randomized controlled trial is urgently needed to establish the efficacy and safety of shorter antifungal courses. These data would be essential to inform clinical decisions and support antifungal stewardship by minimizing unnecessary treatments, lowering costs, limiting resistance, and improving patient outcomes.