What is the treatment for Candida glabrata vaginal infections?

From the Guidelines

The treatment for Candida glabrata vaginal infections should prioritize the use of boric acid vaginal suppositories (600 mg once daily for 14 days) as an alternative to oral azoles, especially in cases where fluconazole resistance is suspected or confirmed, as recommended by the Infectious Diseases Society of America 1. This approach is based on the most recent and highest quality evidence available, which emphasizes the importance of effective treatment for Candida glabrata infections due to their reduced susceptibility to standard azole medications. Key considerations in the treatment of Candida glabrata vaginal infections include:

• The use of boric acid vaginal suppositories as a first-line alternative to oral azoles in cases of fluconazole resistance or susceptibility
• The potential for variable efficacy with nystatin suppositories, as noted in the 2016 clinical practice guideline for the management of candidiasis 1
• The importance of completing the full treatment course, even if symptoms improve quickly, to ensure effective eradication of the infection
• The need for follow-up evaluation to confirm cure, as Candida glabrata infections often recur and may require maintenance therapy in some cases
• The potential benefits of novel treatments, such as oteseconazole, which has shown promise in reducing recurrence rates in women with recurrent vulvovaginal candidiasis (RVVC) 1 It is essential to prioritize the most recent and highest quality evidence when making treatment decisions for Candida glabrata vaginal infections, as this will help to optimize outcomes and minimize the risk of morbidity, mortality, and reduced quality of life.

From the FDA Drug Label

Fluconazole tablets are a prescription medicine used to treat vaginal yeast infections caused by a yeast called Candida. Fluconazole tablet helps stop too much yeast from growing in the vagina so the yeast infection goes away Vaginal candidiasis: Two adequate and well-controlled studies were conducted in the U. S. using the 150 mg tablet. The therapeutic cure rate, defined as a complete resolution of signs and symptoms of vaginal candidiasis (clinical cure), along with a negative KOH examination and negative culture for Candida (microbiologic eradication), was 55% in both the fluconazole group and the vaginal products group

The treatment for Candida glabrata vaginal infections is not directly addressed in the provided drug labels. However, Candida vaginal infections can be treated with fluconazole.

• The therapeutic cure rate for vaginal candidiasis with fluconazole is 55%.
• Fluconazole is administered as a 150 mg single dose for the treatment of vaginal candidiasis.
• The most common treatment-related adverse events reported in patients who received fluconazole for vaginitis were headache (13%), nausea (7%), and abdominal pain (6%) 2. However, it is essential to note that Candida glabrata is not explicitly mentioned in the provided drug labels, and therefore, the effectiveness of fluconazole for this specific type of infection is not directly supported by the provided information 2 2.

From the Research

Treatment Options for Candida glabrata Vaginal Infections

• The treatment of Candida glabrata vaginal infections can be challenging due to its resistance to azole antifungals 3, 4.
• Topical boric acid and flucytosine have been shown to be effective in treating Candida glabrata vaginitis, especially in cases where azole therapy has failed 5, 6.
• Boric acid has been found to have a mycologic cure rate of 40-100% in patients treated for vulvovaginal candidiasis, with minimal adverse effects 6.
• In cases of recurrent or chronic vaginitis, boric acid may be a safe and economic alternative to conventional antifungal treatment 6.

Specific Treatment Approaches

• A study found that topical boric acid (600 mg daily for 2-3 weeks) achieved clinical and mycologic success in 64-71% of symptomatic women with Candida glabrata vaginitis 5.
• Topical flucytosine cream administered nightly for 14 days was associated with a successful outcome in 90% of women whose condition had failed to respond to boric acid and azole therapy 5.
• In cases of Candida krusei (Pichia kudriavzevii) vaginitis, vaginal boric acid has emerged as a treatment method of choice, despite the availability of new antifungal agents 7.

Considerations for Treatment

• Determining the antifungal susceptibility profile of Candida glabrata vaginal isolates may be required in selecting effective antifungal treatment of refractory vaginitis due to non-albicans Candida (NAC) 7.
• Treatment failure and recurrence are common in cases of Candida glabrata vaginitis, highlighting the need for careful management and follow-up 3, 4.