What is the recommended treatment for Candida glabrata infection?

From the Guidelines

The recommended treatment for Candida glabrata infection is an echinocandin, such as caspofungin (70 mg loading dose, then 50 mg daily), micafungin (100-150 mg daily), or anidulafungin (200 mg loading dose, then 100 mg daily), as first-line therapy. This is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1.

Key Considerations

• Treatment duration generally ranges from 14 to 21 days, depending on the infection site and clinical response.
• C. glabrata often shows reduced susceptibility to fluconazole, making echinocandins preferred.
• For less severe cases or step-down therapy, high-dose fluconazole (800 mg daily) may be considered if the isolate demonstrates susceptibility.
• Amphotericin B lipid formulations (3-5 mg/kg daily) serve as alternative therapy when echinocandins cannot be used.
• Source control through removal of infected catheters or drainage of abscesses is crucial for successful treatment.

Important Notes

• Susceptibility testing is important since C. glabrata can develop resistance to multiple antifungal classes.
• Treatment should be adjusted based on clinical response, with monitoring of liver function during therapy due to potential hepatotoxicity of antifungal medications.
• The Infectious Diseases Society of America recommends an echinocandin as initial therapy for most adult patients with Candida glabrata infection 1.

Additional Recommendations

• Transition from an echinocandin to fluconazole is recommended for patients who have isolates that are likely to be susceptible to fluconazole and who are clinically stable 1.
• Voriconazole may be considered as step-down oral therapy for selected cases of candidiasis due to C. krusei or voriconazole-susceptible C. glabrata 1.

From the FDA Drug Label

Table 15: Overall Success Rates Sustained From EOT To The Fixed 12-Week Follow-Up Time Point By Baseline Pathogen C. glabrata 12/36 (33%) 7/21 (33%) The recommended treatment for Candida glabrata infection is not explicitly stated in the provided drug label as being better than other options, voriconazole and amphotericin B followed by fluconazole have similar success rates of 33%. 2

From the Research

Treatment Options for Candida glabrata Infection

• The treatment of Candida glabrata infection typically involves the use of antifungal medications, with the choice of treatment depending on the severity of the infection and the patient's overall health 3, 4, 5.
• Echinocandins, such as caspofungin or micafungin, are often used as first-line therapy for Candida glabrata candidaemia, with the option to transition to oral fluconazole 3, 6, 7.
• Fluconazole can be used as an alternative treatment for Candida glabrata fungemia, particularly in patients who are not severely ill and have a susceptible isolate 4, 5.
• The combination of liposomal amphotericin B with an echinocandin has been shown to be effective in treating Candida glabrata infection in immunosuppressed mice 6.
• Micafungin has been used successfully to treat Candida glabrata-associated urinary tract infections, including those that are resistant to fluconazole 7.

Factors Influencing Treatment Choice

• The severity of illness and the patient's overall health can influence the choice of treatment for Candida glabrata infection 5.
• The susceptibility of the Candida glabrata isolate to antifungal medications can also impact treatment choice, with fluconazole being more effective against susceptible isolates 4, 5.
• The dose of fluconazole used can also affect treatment outcomes, with higher doses being more effective in some cases 4, 5.

Treatment Outcomes

• Treatment outcomes for Candida glabrata infection can vary depending on the choice of antifungal medication and the severity of the infection 3, 4, 5.
• Echinocandins have been shown to be effective in treating Candida glabrata candidaemia, with response rates ranging from 46% to 52% 3, 5.
• Fluconazole has been shown to be effective in treating Candida glabrata fungemia, with response rates ranging from 20% to 49% 4, 5.
• The combination of liposomal amphotericin B with an echinocandin has been shown to be effective in treating Candida glabrata infection in immunosuppressed mice, with complete clearance of infection achieved in some cases 6.