In candidemia and invasive candidiasis, current guidelines increasingly recommend echinocandin initial therapy for many patients while awaiting species identification and susceptibility results, precisely because ERG11-mediated azole resistance is common enough to affect empiric choices. When ERG11 mutations are discovered during therapy for mucosal infections (e.g., oropharyngeal or vulvovaginal candidiasis), clinicians may use alternative topical or systemic agents (e.g., high-dose fluconazole rarely, itraconazole, or nystatin/alternative class agents) depending on site, severity, and susceptibility profile.
Molecular surveillance of ERG11 alleles in hospitals and regions helps infection-control teams detect clonal spread of resistant strains and to update empiric therapy protocols and stewardship efforts accordingly.

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