What is the treatment for Candida krusei infection?

From the Guidelines

For Candida krusei infections, the recommended first-line treatment is intravenous echinocandins, specifically caspofungin, micafungin, or anidulafungin, as stated in the 2016 update by the Infectious Diseases Society of America 1. The typical regimen for caspofungin is a 70 mg loading dose followed by 50 mg daily. For micafungin, use 100 mg daily, and for anidulafungin, a 200 mg loading dose followed by 100 mg daily. Treatment duration is usually 14 days but may be extended based on clinical response. If echinocandins are unavailable or contraindicated, amphotericin B deoxycholate at 0.5-1 mg/kg daily or a lipid formulation of amphotericin B at 3-5 mg/kg daily can be used as an alternative, as suggested by the clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America 1. For less severe cases or step-down therapy, oral voriconazole at 400 mg (6 mg/kg) twice daily for two doses, then 200 mg (3 mg/kg) twice daily, can be effective, as recommended in the clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America 1. It's crucial to avoid fluconazole as C. krusei is inherently resistant to it, as noted in the clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America 1. The choice of echinocandins is based on their broad spectrum of activity against Candida species and their favorable safety profile, as discussed in the clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America 1. Monitor liver function tests during treatment, especially with azoles. For superficial infections, topical nystatin or amphotericin B may be sufficient. Always adjust dosing for renal or hepatic impairment and consider drug interactions, particularly with azoles.

Some key points to consider in the treatment of Candida krusei infections include:

• The importance of avoiding fluconazole due to inherent resistance
• The use of echinocandins as first-line treatment
• The consideration of amphotericin B deoxycholate or lipid formulation of amphotericin B as alternatives
• The potential use of voriconazole for step-down therapy
• The need for monitoring liver function tests and adjusting dosing for renal or hepatic impairment
• The importance of considering drug interactions, particularly with azoles.

Overall, the treatment of Candida krusei infections requires careful consideration of the available options and the individual patient's needs, as well as adherence to established clinical practice guidelines, such as those provided by the Infectious Diseases Society of America 1.

From the FDA Drug Label

C krusei 1/4 The treatment for Candida krusei infection is not explicitly stated in the provided drug labels, but based on the available data, voriconazole may not be the most effective option, as only 1 out of 4 patients with C. krusei infection responded to treatment 2.

From the Research

Treatment Options for Candida krusei Infection

• Caspofungin (CAS) has been shown to be effective against Candida krusei, with fast killing activity at all concentrations 3, 4
• Voriconazole (VOR) has also been found to be effective, with a concentration-independent fungistatic activity against all isolates 3, 5
• Amphotericin B (AmB) has been shown to have a concentration-dependent activity, with synergic interaction detected when combined with CAS 3
• The combination of CAS with VOR or AmB has exhibited promising results, with a high frequency of synergic interaction 3
• Echinocandins, such as caspofungin, are preferred for the treatment of infections with C. krusei, especially in hemodynamically unstable or neutropenic patients 6

Resistance and Susceptibility

• Candida krusei is intrinsically resistant to fluconazole, and other species, such as Candida glabrata, often manifest reduced susceptibility 7, 6
• Voriconazole has been shown to be effective against fluconazole-resistant C. albicans and C. krusei, with a higher potency than fluconazole 5
• Amphotericin B has been found to have a high MIC for some C. krusei isolates, but voriconazole remains effective against these strains 5

Clinical Considerations

• The treatment of invasive Candida krusei infections can be difficult due to its intrinsic resistance to fluconazole and reduced susceptibility to AmB 3
• The choice of antifungal agent depends on the species of the offending pathogen, as well as the patient's clinical status and response to therapy 6
• Central venous catheters should be removed from all patients who have disseminated candidiasis, if feasible, and antifungal therapy should be administered to all patients who have candidemia or proven candidiasis 6