What is the first line treatment for systemic candidiasis?

The first-line treatment for systemic candidiasis in most clinical scenarios is the use of an intravenous echinocandin, such as caspofungin. Echinocandins are preferred due to their broad antifungal activity against Candida species and a favorable safety profile. This class of antifungals works by inhibiting the synthesis of β(1,3)-D-glucan, an essential component of the fungal cell wall, thereby leading to cell lysis and death.

The choice of echinocandin is particularly important in patients who are critically ill or have high levels of resistance, as they provide effective coverage against common resistant strains of Candida. While fluconazole may be considered for systematic candidiasis if the strain is known to be sensitive, echinocandins are generally the recommended first line due to their effectiveness and rapid action.

Nystatin is primarily used topically or in a not-for-systemic-use capacity, which makes it unsuitable for systemic infections. Amphotericin B, while effective against a broad range of fungal infections, is typically reserved for severe cases or when other antifungals are not effective due to its significant side effects and toxicity profile.

Thus, for treating systemic candidiasis, particularly in acutely ill patients