From the Guidelines
For Candida glabrata and non-albicans Candida (NAC) vaginitis, the recommended treatment is typically a longer course of topical azole therapy or boric acid suppositories, with boric acid 600 mg vaginal suppositories used once daily for 14 days being the preferred treatment for C. glabrata specifically, due to its high cure rates of approximately 70% 1.
Treatment Overview
The treatment of Candida glabrata and other non-albicans Candida (NAC) vaginitis is challenging due to their reduced susceptibility to standard azole medications.
- First-line treatment often consists of a 7-14 day course of topical azoles such as clotrimazole 1% cream or miconazole 2% cream applied intravaginally once daily.
- For C. glabrata specifically, boric acid 600 mg vaginal suppositories used once daily for 14 days is the preferred treatment, as it has been shown to have cure rates of approximately 70% 1.
- In cases of recurrent or resistant infection, maintenance therapy may be necessary with weekly boric acid suppositories for several months.
Considerations
- Fluconazole, which works well for C. albicans, is often ineffective against C. glabrata due to intrinsic resistance.
- Patients should be advised to avoid sexual intercourse during treatment or use condoms, maintain good hygiene, wear cotton underwear, and avoid douching.
- These non-albicans species are more challenging to treat because they often have reduced susceptibility to standard azole medications, with C. glabrata in particular having mechanisms that allow it to develop resistance to multiple antifungal classes.
Alternative Treatments
- Nystatin intravaginal suppositories, 100,000 units daily for 14 days, can be used as an alternative treatment for C. glabrata infection 1.
- Topical 17% flucytosine cream can be used alone or in combination with 3% AmB cream in recalcitrant cases 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Candida glabrata and Non-Albicans Candida (NAC) Vaginitis
- Topical boric acid and flucytosine are useful additions to therapy for women with azole-refractory C glabrata vaginitis 2
- Boric acid vaginal suppositories (600 mg/day for 14 days) showed higher mycological cure rates compared to single-dose oral 150-mg fluconazole in diabetic patients with C. glabrata VVC 3
- Boric acid was effective in obtaining mycologic cure in 78% of patients with C. glabrata, while fluconazole was effective as initial treatment in 60% of patients with C. glabrata 4
Efficacy of Fluconazole and Other Treatments
- Fluconazole is effective against non-albicans Candida species, although higher doses may be required for infections caused by Candida glabrata 5
- The efficacy of fluconazole against various species was 93% for Candida parapsilosis, 50% for Candida glabrata, and 82% for Candida tropicalis 5
- Fluconazole showed a cure rate of 100% in women with non-albicans species, while nystatin showed a cure rate of 44.4% in the same group 6
Treatment Considerations
- The choice of treatment for Candida glabrata and NAC vaginitis may depend on the specific species and the patient's response to initial treatment 2, 3, 4
- Boric acid and fluconazole may be considered as treatment options for patients with azole-refractory C glabrata vaginitis or those who have failed initial treatment with other antifungals 2, 3, 4