Status of fluconazole in the therapy of endogenous Candida endophthalmitis

Abstract

During the clinical course of invasive candidosis, endogenous Candida endophthalmitis (ECE) is associated with a higher mortality. In patients with candidemia, an ECE-incidence of 28 to 37% was reported. In i.v.-drug users, the incidence of Candida infections was 21%. Besides surgical procedures including vitrectomy and enucleation, early initiation of systemic antifungal therapy is decisive for the outcome. The clinical use of fluconazole in ECE is documented in 96 patients and in a minimum of 108 eyes. The mean duration of therapy was 6-8 weeks (maximum duration: lifelong) with an average dosage of 200-400 mg/d (maximum dosage: 800 mg/d and 14 mg/kg BW, resp.). The results reported in the literature show a good clinical efficacy of fluconazole in ECE: 90% response rate (19/21) in patients with/without concomitant vitrectomy and with/without concomitant use of other antifungals, complete disappearance of all eye lesions in 94% (15/16) non-neutropenic patients with candidemia and in 86% (6/7) ECE-patients addicted to heroin. With respect to these favorable results, fluconazole plays an important role in the standard therapy of ECE.