The como tratar candidiase infections vary substantially and are based on the anatomic location of the infection, the patients’ underlying disease and immune status, the patients’ risk factors for infection, the specific species of Candida responsible for infection, and, in some cases, the susceptibility of the Candida species to specific antifungal drugs.
There have been significant changes in the management of candidiasis in the last few years, particularly related to the appropriate use of echinocandins and expanded-spectrum azoles for candidemia, other forms of invasive candidiasis, and mucosal candidiasis. Updated guidelines were published in 2016 by the Infectious Disease Society of America (IDSA),  replacing previous versions from 2009  and 2004.  These latest recommendations include the echinocandins caspofungin, micafungin, and anidulafungin, along with fluconazole, as well as lipid formulations of amphotericin B in various situations.
Fluconazole is still considered a first-line agent in nonneutropenic patients with candidemia or suspected invasive candidiasis.Para continuar vencendo a candidiase However, a post-hoc analysis of clinical trial data comparing anidulafungin with fluconazole for treatment of invasive candidiasis found that anidulafungin was more effective in treating severely ill patients.  A revision of data outcomes on treatment of invasive candidiasis in clinical trials appears to favor use of echinocandins in terms of increased rate of survival. This type of finding may have an impact on future treatment recommendations and strategies of drug use for invasive candidiasis in different groups of patients. [31, 32]
In August 2013, the FDA announced that clinicians should no longer prescribe ketoconazole (Nizoral, Janssen Pharmaceuticals) tablets as a first-line therapy for any fungal infection, including Candida and dermatophyte infections, because of the risk for severe liver injury, adrenal insufficiency, and adverse drug interactions. [33, 34] The FDA also cautioned that ketoconazole tablets should not be prescribed for any patient with underlying liver disease. The labeling changes do not apply to topical formulations of ketoconazole in creams, shampoos, foams, and gels. Oral ketoconazole is now indicated only for endemic mycoses in patients who fail to respond to or cannot tolerate other treatments.
Ketoconazole tablets were also withdrawn from the market in the European Union in July 2013. [33, 34]
The therapeutic options available for the management of invasive candidiasis and candidemia have continued to increase with the addition of newer echinocandins [35, 36] and triazoles.
Cutaneous candidiasis: Most localized cutaneous candidiasis infections may be treated with any number of topical antifungal agents (eg, clotrimazole, econazole, ciclopirox, miconazole, ketoconazole, nystatin). If the infection is a paronychia, the most important aspect of therapy is drainage of the abscess, followed by oral antifungal therapy with either fluconazole or itraconazole. In cases of extensive cutaneous infections, infections in immunocompromised patients, folliculitis, or onychomycosis, systemic antifungal therapy is recommended. For Candida onychomycosis, oral itraconazole (Sporanox) appears to be most efficacious. Two treatment regimens are available: the daily dose of itraconazole taken for 3-6 months or the pulsed-dose regimen that requires a slightly higher daily dose for 7 days, followed by 3 weeks of no drug administration. The cycle is repeated every month for 3-6 months.
Oropharyngeal candidiasis OPC can be treated with either topical antifungal agents (eg, nystatin, clotrimazole, amphotericin B oral suspension) or systemic oral azoles (fluconazole, itraconazole, or posaconazole).
como curar a candidiase Infections in HIV-positive patients tend to respond more slowly and, in approximately 60% of patients, recur within 6 months of the initial episode. Approximately 3%-5% of patients with advanced HIV infection (CD4 cell counts < 50/µL) may develop refractory OPC. In these situations, in addition to attempting correction of the immune dysfunction with HAART, higher doses of fluconazole (up to 800 mg/d) or itraconazole (up to 600 mg/d) can be attempted. Posaconazole suspension at 400 mg orally twice per day has also yielded excellent results in such patients. Additionally, caspofungin 50 mg/d IV and anidulafungin 100 mg/d IV have also yielded excellent efficacy in such patents. Amphotericin B is rarely necessary to treat such cases, but, when used, low doses of amphotericin B can be used (0.3-0.7 mg/kg) and have been shown to be effective.
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