Which antifungals, route of administration and duration of treatment should be utilized to treat fungal periprosthetic joint infections (PJIs)?

Authors: Katherine Belden, Jiying Chen, Feng-Chih Kuo, Rui Li, Jun Fu, Xiangpeng Kong,
Haitao Guan, Tao Deng, Chengqi Jia
RECOMMENDATION: Fluconazole, by both oral and intravenous routes, is currently the treatment of choice for PJIs due to susceptible fungi, including the Candida species which are responsible for the majority of fungal PJI cases. Amphotericin B lipid formulations or echinocandins given intravenously are secondary considerations, but may be less well tolerated. Culture data including antifungal susceptibilities should be used to
guide therapy. Two-stage revision is currently the standard of care. Antifungal treatment should be administered during the spacer interval with a minimum treatment duration of six weeks. Following revision, treatment with oral fluconazole (400mg daily) should be continued for three to six months, if tolerated.
LEVEL OF EVIDENCE: Limited
DELEGATE VOTE: Agree: 92%, Disagree: 3%, Abstain: 5% (Super Majority, Strong Consensus)

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