Invasive candidiasis in critical care setting, updated recommendations from “Invasive Fungal Infections-Clinical Forum”, Iran

Table 1 Recommended treatment options for invasive candidiasis in adult non-neutropenic critically-ill patients based on the current international and local practice guidelines/consensus statements

Guideline	First choice	First alternative	Second alternative
ECCMID[15]	ECH	VCZ, L-AMB	FCZ
European experts opinion[16]	FCZ (stable patients and susceptible isolates) ECH (severe sepsis, micafungin last choice)	L-AmB
IDSA[14]	FCZ (stable patients, azole naive) ECH (critically ill, Severe sepsis, recent azole exposure)	AmB or L-AmB	VCZ
Canadian practice guideline for invasive candidiasis in adults[17]	FCZ (stable patients, azole naïve) ECH (stable or unstable patients, recent azole exposure, avoid in C. parapsilosis)	AmB or L-AmB
Consensus statement from the Iranian panel of experts[12]	FCZ (stable, No prior azole exposure, when hospital epidemiology indicates low incidence of NAC Spp.) ECH (hemodynamic instability, Fluconazole resistance)	VCZ, AmB or L-AmB (if available), considering the tolerability and cost vs utility

ECCMID: European Congress of Clinical Microbiology and Infectious Diseases; ECH: Echinocandins; VCZ: Voriconazole; AmB: Amphotericin B; L-AmB: Liposomal Amphotericin B; FCZ: Fluconazole; IDSA: Infectious Disease Society of America; NAC: Non-albicans Candida.