Would you consider stepping down from an echinocandin to azole therapy prior to the end of an initial six-week course for fluconazole-susceptible Candida albicans endocarditis in the absence of valve surgery?

I would not step down to fluconazole prior to completing a six-week course of echinocandin therapy. Fluconazole has poor activity against Candida biofilms in contrast to the echinocandins. Fluconazole monotherapy has also been associated with poor outcomes in endocarditis.

Admittedly, most of our un...