Duration of antifungal treatment and development of delayed complications in patients with candidaemia

Abstract

The optimal duration of antifungal treatment of candidaemia is unknown. Prolonged treatment has been advocated to prevent late-onset complications caused by metastatic infectious foci. To evaluate the relationship between duration of antifungal therapy and the development of delayed complications in patients with candidaemia, a retrospective descriptive study was performed in a tertiary care centre. The study included 180 consecutive patients with candidaemia identified by at least one positive blood culture. Development of late-onset complications of candidaemia during long-term follow-up was monitored. Of the patients treated with antifungal agents, 55% completed treatment without apparent complications, 33% died during therapy, 12% developed disseminated disease and one patient continues to receive ongoing treatment. Of the 81 patients who completed treatment as scheduled, 25% received treatment for less than 2 weeks, 31% for 2-4 weeks and 38% for more than 4 weeks; duration of therapy was unknown in 6%. Only three (2%) patients developed delayed complications; in these patients, the duration of antifungal treatment had been 3 weeks, 5 weeks and 22 weeks, respectively. In conclusion, despite theoretical concerns, there seems to be no correlation between the duration of antifungal treatment and the development of late complications in patients with candidaemia. This suggests that treatment of 2 weeks or less may be sufficient, provided the initial response to therapy is favourable.