What is the recommended first-line treatment for candidemia?

The recommended first-line treatment for candidemia is fluconazole because it is well tolerated and effective against most species of Candida that typically cause bloodstream infections. Fluconazole is a systemic antifungal agent that works by inhibiting the synthesis of ergosterol, an essential component of the fungal cell membrane, leading to increased permeability and cell lysis.

For candidemia, fluconazole is often preferred due to its oral and intravenous availability, favorable pharmacokinetics, broad activity, and established efficacy in numerous studies. It is particularly effective against non-albicans Candida species, which are increasingly common in clinical cases.

Other options, while antifungal agents, are either not first-line or have specific use cases that limit their initial recommendation in candidemia. Itraconazole has a narrower spectrum and is generally not used for candidemia due to its variable absorption and clinical efficacy. Amphotericin B is often reserved for severe infections or cases where resistance is suspected, due to its potential for toxic side effects. Nystatin is primarily utilized for mucosal Candida infections and not for systemic infections like candidemia.

Fluconazole's effectiveness, safety profile, and broad-spectrum activity make it the standard first-line therapy in treating candidemia.