American Board of Internal Medicine (ABIM) Certification Practice Exam

What class of antifungal medication is used for the treatment of candidemia?

1. Azoles

2. Polyenes

3. Echinocandins

4. Both a and c

The correct answer is: Both a and c

Candidemia, a bloodstream infection caused by Candida species, generally requires prompt treatment with antifungal medications. Both azoles and echinocandins are effective classes of antifungal agents that are commonly utilized in the management of candidemia. Azoles, such as fluconazole, are widely prescribed for candidemia due to their broad-spectrum activity against various Candida species. They work by inhibiting the synthesis of ergosterol, a crucial component of the fungal cell membrane, thereby disrupting the integrity and function of the membrane and leading to cell death. Echinocandins, such as caspofungin, anidulafungin, and micafungin, are another class of antifungals that are particularly effective for candidemia. They act by inhibiting the synthesis of beta-(1,3)-D-glucan, an essential component of the fungal cell wall. This action weakens the cell wall, rendering the organism more susceptible to osmotic stress, which can ultimately cause cell lysis. Combining both azoles and echinocandins gives clinicians a robust arsenal against candidemia, especially in cases where the causative organism may be resistant to one class. Therefore, the inclusion of both azoles and