From the Guidelines
For infections due to Candida glabrata, an echinocandin is the preferred treatment option. This recommendation is based on the clinical practice guidelines for the management of candidiasis updated by the Infectious Diseases Society of America in 2009 1. The guidelines suggest that echinocandins are preferred over other treatment options due to their effectiveness and relatively lower risk of toxicity.
Treatment Options
- Echinocandins, such as micafungin, caspofungin, or anidulafungin, are considered first-line treatment for C. glabrata infections 1.
- Liposomal amphotericin B (LFAmB) is an effective but less attractive alternative due to its higher cost and potential for toxicity 1.
- For patients who are already receiving voriconazole or fluconazole and show clinical improvement with negative follow-up culture results, continuing the use of the azole to completion of therapy is reasonable 1.
Key Considerations
- C. glabrata often exhibits reduced susceptibility to azole antifungals, making echinocandins a more reliable treatment option 1.
- Proper identification of C. glabrata through laboratory testing is crucial for effective management, as its appearance and drug susceptibility differ from other Candida species.
- Risk factors for C. glabrata infections include diabetes, recent antibiotic use, immunosuppression, and the presence of indwelling medical devices.
From the Research
Candida glabrata Overview
- Candida glabrata is a leading cause of disseminated candidiasis, especially in patients with underlying immunosuppression 2.
- It is frequently resistant to azole drugs, resulting in difficult-to-treat multidrug-resistant strains 2.
Echinocandin Resistance
- Echinocandin drugs, such as micafungin, anidulafungin, and caspofungin, are the preferred choice to treat a range of candidiasis 2.
- However, higher-level resistance has been reported among Candida glabrata, involving amino acid changes in "hot spot" regions of FKS-encoded subunits of glucan synthase 2.
- The mechanism of echinocandin resistance decreases the sensitivity of the enzyme to the drug, resulting in higher minimum inhibitory concentration values 2.
Treatment Options
- The optimal regimen for the treatment of invasive Candida glabrata infections in neutropenic patients is not known, but higher human dosages of echinocandins are required to induce fungicidal effects 3.
- Combination therapy with liposomal amphotericin B and an echinocandin, such as caspofungin or micafungin, has been shown to be effective in treating Candida glabrata infections 4.
- Synergistic activity has been observed when anidulafungin is combined with voriconazole or posaconazole against echinocandin/azole-resistant Candida glabrata isolates 5.
Clinical Applications
- Micafungin has been used to successfully treat Candida glabrata-associated urinary tract infections, providing an alternative and effective therapy against this organism 6.
- Clinical factors that promote echinocandin resistance include prophylaxis, host reservoirs, and intra-abdominal infections, highlighting the need for careful consideration of treatment strategies 2.