Review Question - QID 215473

Numerous antifungals have been described for the treatment of fungal periprosthetic joint infections (PJI), however, Fluconazole is commonly chosen given its similar efficacy with oral and IV formulations.

Fungal PJI is a devastating complication as they can be difficult to diagnose, effectively manage, and eradicate. Surgical management mirrors that seen with bacterial PJI. Similarly, systemic anti-fungal therapy is critical to successful management of these patients. Debate exists regarding the ideal agent, route of administration, and duration of treatment. Fluconazole is commonly selected because of its similar efficacy through IV and oral formulations and its safer side effect profile compared to other anti-fungals.

Kuo et al. review two-stage exchange arthroplasty and the treatment of fungal PJI. They report that fungal PJI accounted for 2.4% off all PJI and had very poor outcomes following both single and two stage revision with 33% and 46% success rates at 5 years, respectively. They conclude that given their poor results, debridement and single stage revision have no place in the treatment of fungal PJI.

Nace et al. review the diagnosis and management of fungal periprosthetic infections. They report that Fluconazole is the most commonly selected anti-fungal for systemic treatment given its similar efficacy in oral and IV formulations. They conclude adjunctive local and systemic therapy is critical in effectively treating these patients.

Incorrect Answers:
Answer 2: Candida resistance to Fluconazole is increasing.
Answer 3: Renal function does not need to be monitored in patients taking Fluconazole.
Answer 4: Fluconazole is heat stable and can be included in cement.
Answer 5: There is a risk of hepatotoxicity with Fluconazole and jaundice is a common side effect.