Which benzodiazoles (antifungal medications) are effective against Candida (fungal infection)?

From the Guidelines

Bendazols, such as fluconazole, are effective against Candida, with fluconazole being the preferred initial therapy in selected patients, including those who are not critically ill and who are considered unlikely to have a fluconazole-resistant Candida species 1. The treatment of Candida infections involves the use of antifungal medications, with bendazols being a class of drugs that include fluconazole, itraconazole, and voriconazole.

• Fluconazole is typically prescribed at a loading dose of 800-mg (12 mg/kg), then 400 mg (6 mg/kg) daily 1.
• Itraconazole and voriconazole can be used as alternative therapies, but their use is generally reserved for more resistant infections or specific cases, such as C. krusei 1. The mechanism of action of these medications involves the inhibition of ergosterol synthesis in the fungal cell membrane, disrupting membrane integrity and leading to cell death.
• For optimal effectiveness, fluconazole can be taken with or without food, while itraconazole and voriconazole absorption is improved when taken with meals.
• Patients should complete the full course of treatment, even if symptoms improve quickly, to prevent recurrence.
• Those with liver disease may require dose adjustments, and drug interactions should be carefully monitored, particularly with medications metabolized through the CYP450 enzyme system. It is essential to note that the choice of antifungal therapy should be guided by the susceptibility of the Candida isolate, as well as the clinical status of the patient, with fluconazole being a recommended initial therapy in selected patients 1.

From the FDA Drug Label

For patients who were infected with a single pathogen and were refractory to, or intolerant of, other antifungal agents, the satisfactory response rates for voriconazole in studies 304 and 309/604 are presented in Table 14. Table 15: Overall Success Rates Sustained From EOT To The Fixed 12-Week Follow-Up Time Point By Baseline Pathogen a,b Baseline Pathogen Clinical and Mycological Success (%) Voriconazole Amphotericin B --> Fluconazole C. albicans 46/107 (43%) 30/63 (48%) C. tropicalis 17/53 (32%) 1/16 (6%) C. parapsilosis 24/45 (53%) 10/19 (53%) C. glabrata 12/36 (33%) 7/21 (33%) C krusei 1/4 0/1 Table 17: Clinical and Mycological Outcome by Baseline Pathogen in Patients with Esophageal Candidiasis (Study-150-305) Pathogen a Voriconazole Fluconazole Favorable endoscopic response b Mycological eradication b Favorable endoscopic response bMycological eradication b C. albicans 134/140 (96%) 90/107 (84%) 147/156 (94%) 91/115 (79%) C. glabrata 8/8 (100%) 4/7 (57%) 4/4 (100%) 1/4 (25%) C. krusei 1/1 1/1 2/2 (100%) 0/0

The effective bendazols against Candida are:

• Voriconazole 2: effective against C. albicans, C. tropicalis, C. parapsilosis, C. glabrata, and C. krusei
• Fluconazole 3: effective against Candida species, including C. albicans, C. glabrata, and C. krusei

Key points:

• Voriconazole has shown efficacy against various Candida species, including C. albicans, C. tropicalis, C. parapsilosis, C. glabrata, and C. krusei.
• Fluconazole is also effective against Candida species, including C. albicans, C. glabrata, and C. krusei.

From the Research

Effective Bendazols Against Candida

• Fluconazole is effective against Candida albicans infections, including oropharyngeal and esophageal candidiasis, vulvovaginal candidiasis, candidemia, and disseminated candidiasis 4, 5
• Itraconazole is also effective against Candida albicans infections, particularly in cases where fluconazole treatment fails 4
• Voriconazole, posaconazole, and isavuconazole have been shown to have inhibitory and fungicidal activities against clinical isolates of Trichosporon asahii, although their effectiveness against Candida is not as well established 6
• The effectiveness of these bendazols against Candida auris biofilms is limited, with high MICs observed for fluconazole, itraconazole, posaconazole, and voriconazole 7

Comparison of Bendazols

• Fluconazole and itraconazole have been compared in several studies, with fluconazole generally considered a first-line treatment option for Candida albicans infections 4, 5
• Voriconazole has been shown to have a lower MIC than fluconazole and itraconazole against Trichosporon asahii 6
• The effectiveness of bendazols against Candida auris biofilms is limited, with deoxycholate amphotericin B showing higher activity than triazoles, echinocandins, and liposomal amphotericin B 7

Limitations and Future Directions

• The number of antifungal drugs available for treatment of Candida infections is limited, and there is an urgent need for development of new drugs and alternative therapeutic options 8
• Further studies are needed to determine the clinical significance of the combinatory effect of fluconazole and other FDA-approved drugs against Candida albicans 8
• The effectiveness of bendazols against Candida auris biofilms requires further investigation, particularly in light of the limited activity observed in vitro 7