OBJECTIVES: Serious candida infections have been treated with a variety of patterns of antifungal drugs. This study focused on the outcomes of hospitalized patients treated with antifungal drugs and examined drug switching approaches in actual practice. METHODS: A retrospective study was conducted among a population of 9746 serious candida infection patients treated with antifungal drugs during the time period of February 2003 to June 2005. Data was collected from 441 hospitals out of the Solucient® ACTracker™ database. Patients were categorized into an adherence group with patients staying in aggressive drugs (IV forms of amphotericin B, amphotericin B lipids, cancidas and vfend) and a switching group with patients who switched from aggressive drugs to non-aggressive and less expensive drugs (oral forms only of amphotericin B, sporanox, diflucan & vfend). Mortality and length of stay (LOS) of the two groups were compared by Chi square and T test. Further analysis was followed by using Logistics regression and ANCOVA analysis with controlled influencing factors such as co-morbidities. RESULTS: The drug switching patients group was found to have significantly higher mortality rate (0.246 vs 0.160, Chi=29.68, p<0.001) and longer LOS (36.45 vs 27.73, t=7.67, p<0.001) as compared to adherence group. The higher mortality in switching group was supported by Logistic regression results with the following confounding factors controlled: age (OR 1.013, CI:1.009-1.017), septicemia (OR 1.231, CI:1.055-1.451), kidney disease(OR 1.288, CI:1.091-1.52), ER(OR 1.362, CI:1.083-1.712) and other candida (OR 1.440, CI:1.039-1.996). The extended LOS also was found by using ANCOVA with confounding factors adjusted including mycoses, ER admission, Medicare payment. CONCLUSIONS: The study demonstrated that switching aggressively treated patients to cheaper and less aggressive drugs caused higher mortality and extended hospital stay. More extensive clinical and economic outcome studies are needed to understand antifungal drug treatment in candida infection patients.