American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for candidemia in a postsurgical patient?

1. Fluconazole

2. Echinocandins

3. Amphotericin B

4. Voriconazole

The correct answer is: Echinocandins

Echinocandins are considered the first-line treatment for candidemia, especially in a postsurgical patient. This class of antifungal agents includes drugs such as caspofungin, micafungin, and anidulafungin, which are preferred due to their rapid action and efficacy against the majority of Candida species, particularly in more severe infections or when the patient is critically ill. In a postsurgical setting, patients are often at higher risk for invasive fungal infections due to factors such as altered immune status, prolonged hospital stays, and exposure to broad-spectrum antibiotics. Echinocandins demonstrate good tissue penetration and have a favorable safety profile, making them an excellent choice in such scenarios. The ability to rapidly take effect and their use in empirical therapy are also vital in managing potential severe complications that could arise from invasive candidiasis. While other antifungal options, such as fluconazole and amphotericin B, have their roles, they may not be the most effective initial choices for this particular situation. For instance, fluconazole is typically used for less severe forms of candidiasis and may not be appropriate in the case of azole-resistant Candida species. Amphotericin B, while effective, is associated with more significant side