American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is NOT a first-line treatment for candidemia?

1. Anidulafungin

2. Voriconazole

3. Micafungin

4. Flucytosine

The correct answer is: Flucytosine

In the context of treating candidemia, the focus is on effective antifungal therapies that are recommended as first-line treatments. Anidulafungin, micafungin, and voriconazole are all established options for managing candidemia, particularly in invasive infections caused by Candida species. Flucytosine, however, is not recommended as a first-line treatment for candidemia. While it can be used in combination with other antifungals for certain invasive fungal infections, it is primarily used for cryptococcal meningitis and not for candidemia. Flucytosine's use alone in candidemia could lead to inadequate treatment, especially in cases of severe infection, where echinocandins (like anidulafungin and micafungin) or azoles (such as voriconazole) would be more appropriate due to their effectiveness against Candida species. This distinction is crucial in clinical practice, as it guides healthcare providers in selecting the most efficacious treatment protocols for their patients suffering from bloodstream infections caused by yeast.