From the Guidelines
The recommended treatment for vaginal Candida glabrata infections is boric acid suppositories (600 mg) inserted vaginally once daily for 14 days. This approach is preferred because C. glabrata often shows resistance to standard azole antifungals like fluconazole 1. For persistent infections, alternative options include nystatin suppositories, 100,000 units daily for 14 days 1, flucytosine cream, or compounded amphotericin B vaginal suppositories.
Some key points to consider in the treatment of vaginal Candida glabrata infections include:
- Confirming the diagnosis through culture since symptoms alone cannot distinguish between different Candida species 1
- Completing the full treatment course even if symptoms improve quickly
- Avoiding sexual intercourse during treatment
- Considering partner treatment if recurrence is an issue
- Being aware that C. glabrata infections are particularly challenging due to the species' ability to form biofilms and actively pump drugs out of fungal cells, which may require longer treatment courses 1
It's also important to note that treatment of C. glabrata vulvovaginal candidiasis can be problematic, and azole therapy, including voriconazole, is frequently unsuccessful 1. Therefore, topical intravaginal boric acid is a strong recommendation for the treatment of C. glabrata vulvovaginitis that is unresponsive to oral azoles 1.
From the Research
Treatment Options for Vaginal Candida glabrata
- The recommended treatment for vaginal Candida glabrata infections is often challenging due to its resistance to many azole antifungal agents, especially fluconazole 2, 3, 4.
- Some studies suggest that micafungin, a new echinocandin drug, in combination with topical ciclopirox olamine, may be effective in treating chronic recurrent vulvovaginal candidiasis caused by C. glabrata 2.
- Posaconazole has also shown efficacy in reducing the load of C. glabrata in a murine model of vaginitis, and may be a viable treatment option 3.
- Vaginal nystatin suppositories have been shown to be effective in treating RVVC caused by C. glabrata, with a mycological cure rate of 64.3% 5.
- Combined topical flucytosine and amphotericin B may also be effective in treating refractory vaginal C. glabrata infections 6.
- Other treatment options, such as oral itraconazole, oral dydrogesterone, and local application of 1% gentian violet, have also been reported to be effective in some cases 4.
Comparison of Treatment Options
- A study comparing the efficacy of vaginal nystatin suppositories and oral fluconazole for the treatment of RVVC found that both treatments were effective, but nystatin may be more effective for RVVC caused by C. glabrata or fluconazole-resistant Candida 5.
- Another study found that posaconazole was more effective than fluconazole in reducing the load of C. glabrata in a murine model of vaginitis 3.