As the U.S. reports a rise in Candida auris cases, which spreads rapidly in healthcare sites, there are five drugs recommended to treat the fungus infections, according to the CDC.
The fungus has become more drug-resistant, but the CDC has initial echinocandin therapies recommended for clinical cases of C. auris. The agency says patients should be "carefully monitored for clinical improvement" because of the increase in resistance.
For patients 2 months old and older:
- Anidulafungin: Intravenous loading dose 200 milligrams and then inject 100 milligrams daily intravenously for adults. It is not approved for use in children.
- Caspofungin: For adults, the loading dose is 70 milligrams intravenously, which is followed up with 50 milligrams intravenously daily. For children, the loading dose is 70 milligrams intravenously divided by the patient's body surface area. Then, the treatment is 50 milligrams intravenously divided by body surface area each day.
- Micafungin: Adults should be treated with 100 milligrams intravenously each day. For children, the recommended dosing is 2 milligrams intravenously divided by kilograms, with the option to increase to 4 milligrams intravenously divided by kilograms each day if the child weighs at least 40 kilograms, or 88 pounds.
"Switching to a liposomal amphotericin B (5 milligrams divided by kilogram daily) could be considered if the patient is clinically unresponsive to echinocandin treatment or has persistent fungemia for more than five days," the CDC added.
For patients younger than 2 months, amphotericin B deoxycholate (1 milligram divided by kilogram daily) is the preferred treatment listed. Liposomal amphotericin B (5 milligrams divided by kilogram daily) could be considered if the former is not working. "Exceptional circumstances" may call for echinocandins, the agency said.
In those cases, the daily dosages are 25 milligrams intravenously per kilogram of caspofungin or 10 milligrams intravenously per kilogram of micafungin.
Supply
There are no solutions available of amphotericin B lipid complex, intravenous suspension for injection, 100 milligrams, according to the American Society of Health-System Pharmacists.
Mylan Pharmaceuticals discontinued one solution of caspofungin in 2020, but as of March 21, 2023, there are no reported shortages of this drug, according to databases tracked by the FDA and the ASHP.