What is the first line therapy for symptomatic systemic candidiasis that is stable and sensitive?

Fluconazole is considered the first-line therapy for symptomatic systemic candidiasis in patients who are stable and whose infections are known to be sensitive to the drug. This is due to its well-established efficacy, safety profile, and pharmacokinetic properties, allowing for appropriate tissue penetration and absorption in the body. Fluconazole is part of the azole class of antifungals and is particularly effective against Candida species, making it a preferred option in cases where the infection is not severe and where the patient's clinical condition permits oral or IV dosing.

In cases where an echinocandin could be indicated (such as in more severe infections or in those with resistance), fluconazole remains the go-to choice when the organism is confirmed to be sensitive to it. Other therapies, such as itraconazole or nystatin, may be less effective for systemic candidiasis and are typically reserved for different clinical scenarios or specific patient populations. Thus, fluconazole effectively addresses stable infections caused by sensitive strains of Candida, establishing it as the first-line therapy in these instances.