Peter G. Pappas,1 Carol A. Kauffman,2 David Andes,4 Daniel K. Benjamin, Jr.,5 Thierry F. Calandra,11 John E. Edwards, Jr.,6 Scott G. Filler,6 John F. Fisher,7 Bart-Jan Kullberg,12 Luis Ostrosky-Zeichner,8 Annette C. Reboli,9 John H. Rex,13 Thomas J. Walsh,10 and Jack D. Sobel3

1University of Alabama at Birmingham, Birmingham; 2University of Michigan and Ann Arbor Veterans Administration Health Care System, Ann
Arbor, and 3Wayne State University, Detroit, Michigan; 4University of Wisconsin, Madison; 5Duke University Medical Center, Durham, North
Carolina; 6Harbor–University of California at Los Angeles Medical Center, Torrance; 7Medical College of Georgia, Augusta; 8University of Texas at
Houston, Houston; 9Cooper Hospital, Camden, New Jersey; 10National Cancer Institute, Bethesda, Maryland; 11Centre Hospitalier Universitaire
Vaudois, Lausanne, Switzerland; 12Nijmegen University Centre for Infectious Diseases, Nijmegen, The Netherlands; and 13Astra Zeneca
Pharmaceuticals, Manchester, United Kingdom

    Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults.This new information is incorporated into this revised document.

EXECUTIVE SUMMARY

    There have been several significant changes in the management of candidiasis since the last publication of these guidelines in January 2004. Most of these changes relate to the appropriate use of echinocandins and expanded spectrum azoles in the management of candidemia, other forms of invasive candidiasis, and mucosal candidiasis. For some of the less common forms of invasive candidiasis (e.g., chronic disseminated candidiasis,osteomyelitis, and CNS disease), there are few new treatment data since 2004, with only anecdotalexperience, case reports, or small series providing some evidence to support new approaches to therapy. Each section of the Guideline begins with a specific clinical question and is followed by numbered recommendations and a summary of the most-relevant evidence in support of the recommendations. The most significant changes and/or additions to existing recommendations are described below in the Executive Summary. The remaining topics are discussed in greater detail in the main body of the guidelines.

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