From the Guidelines
Treatment of Candida glabrata in urine is generally not recommended unless the patient is symptomatic or has risk factors for dissemination, in which case oral flucytosine or amphotericin B may be considered. According to the 2016 clinical practice guideline for the management of candidiasis by the Infectious Diseases Society of America 1, fluconazole is not effective against C. glabrata due to intrinsic resistance. For fluconazole-resistant C. glabrata, AmB deoxycholate, 0.3–0.6 mg/kg daily for 1–7 days with or without oral flucytosine, 25 mg/kg 4 times daily, is recommended 1. Some key points to consider when treating Candida glabrata in urine include:
- Elimination of urinary tract obstruction is strongly recommended 1
- Removal or replacement of urinary catheters, such as nephrostomy tubes or stents, should be considered if feasible 1
- Treatment should be individualized based on the patient's symptoms, risk factors, and underlying medical conditions
- Systemic therapy with intravenous echinocandins may be necessary in severe cases, although this is not explicitly recommended in the guideline 1.
From the FDA Drug Label
Patients were treated with randomized study drug for a median of 15 days. Most of the candidemia in patients evaluated for efficacy was caused by C. albicans (46%), followed by C. tropicalis (19%), C. parapsilosis (17%), C. glabrata (15%), and C krusei (1%). In Studies 608 and 309/604 (non-comparative study in patients with invasive fungal infections who were refractory to, or intolerant of, other antifungal agents), voriconazole was evaluated in 35 patients with deep tissue Candida infections A favorable response was seen in 4 of 7 patients with intra-abdominal infections, 5 of 6 patients with kidney and bladder wall infections
Treatment of Candida glabrata in urine is not directly addressed. However, the drug label does mention that voriconazole was evaluated in patients with deep tissue Candida infections, including those with kidney and bladder wall infections, and a favorable response was seen in 5 of 6 patients.
- Candida glabrata was one of the species isolated in the studies, with a success rate of 33% in the treatment of candidemia. However, there is no direct information on the treatment of Candida glabrata in urine. 2
From the Research
Treatment of Candida Glabrata in Urine
- Candida glabrata is a type of fungus that can cause urinary tract infections, and its treatment can be challenging due to increasing multi-drug resistance 3.
- Several antifungal agents, including fluconazole, micafungin, and posaconazole, have been studied for the treatment of Candida glabrata infections 4, 5, 6, 7.
- Fluconazole is often used to treat Candida glabrata infections, but its effectiveness can be limited by resistance, and higher doses may be needed to achieve successful treatment 4.
- Micafungin, an echinocandin, has been shown to be effective in treating Candida glabrata urinary tract infections, even in cases where the organism is resistant to fluconazole 3, 6.
- Posaconazole, a triazole antifungal agent, has also been studied for the treatment of Candida glabrata infections and may be a useful option in cases where the isolate is resistant to fluconazole 7.
Treatment Options
- Removing predisposing factors, such as indwelling catheters and antibiotics, can clear candiduria in almost 50% of asymptomatic patients 5.
- Fluconazole is the antifungal agent of choice for treating symptomatic Candida urinary tract infections, achieving high urine concentrations with the oral formulation 5.
- Micafungin and posaconazole may be considered as alternative treatment options for Candida glabrata urinary tract infections, particularly in cases where the organism is resistant to fluconazole 3, 6, 7.