Voriconazole and amphotericin B equally effective in patients with ocular candidiasis
by Reviewed by Aaron Hamilton, MD, MBA, Vijaiganesh Nagarajan, MD, MRCP, Anbazhagan Prabhakaran, MD, MRCP, Thadeo Catacutan, MD, Chadi Alraies, MD, Rubin Bahuva, MD, Department of Hospital Medicine, Cleveland Clinic
Clinical question: In patients with candidemia, what are the incidence, risk factors, and antifungal treatment outcomes for ocular candidiasis?
Background: The incidence and treatment outcomes of ocular candidiasis have not been studied extensively.
Study design: Randomized noninferiority trial.
Setting: Multicenter study of 370 patients.
Synopsis: This study randomized 370 non-neutropenic patients with candidemia in a 2:1 ratio to receive voriconazole monotherapy or amphotericin B followed by fluconazole. Patients were treated for at least two weeks after the last positive blood culture, for a maximum duration of eight weeks. Baseline and follow-up fundoscopic examinations were performed.
Sixty (16%) patients were diagnosed with ocular candidiasis, of which six (1.6%) were diagnosed with endophthalmitis and 34 (9%) with chorioretinitis. Patients with ocular candidiasis had a longer duration of candidemia, and were more likely to be infected with Candida albicans.
Outcomes were not available in 19 patients with ocular candidiasis due to death or loss of follow-up. There was no significant difference between the cure rate of voriconazole (93.5% [29/31]), compared with the amphotericin B group (100% [10/10]).
Bottom line: Ocular candidiasis occurs in approximately 16% of non-neutropenic patients with candidemia. A longer duration of candidemia and infection with C. albicans were associated with ocular candidiasis. Both voriconazole and amphotericin B/fluconazole are effective in patients with ocular candidiasis.
Citation: Oude Lashof AM, Rothova A, Sobel JD, et al. Ocular manifestations of candidemia. Clin Infect Dis. 2011;53:262-268.
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