From the Guidelines
Fluconazole is the preferred therapy for Candida lusitaniae infections, particularly at a dose of 6 mg/kg per day, due to the potential resistance of this species to amphotericin B. The choice of antifungal therapy for Candida lusitaniae is guided by the susceptibility patterns of the organism, with fluconazole being a suitable option as indicated by studies 1.
Key Considerations
- Candida lusitaniae often exhibits resistance to amphotericin B, making fluconazole a more reliable choice 1.
- Echinocandins, such as caspofungin and voriconazole, may also be effective against C. lusitaniae, although fluconazole is specifically recommended in the guidelines 1.
- The dosage of fluconazole for treating C. lusitaniae infections is typically 6 mg/kg per day, as suggested by the guidelines 1.
Treatment Approach
- Fluconazole at 6 mg/kg per day is the preferred initial therapy for Candida lusitaniae infections, considering its efficacy and the potential resistance issues with amphotericin B 1.
- In cases where fluconazole is not suitable or effective, alternative antifungals like echinocandins (e.g., caspofungin, micafungin) or voriconazole may be considered, taking into account the specific susceptibility pattern of the isolate 1.
- Antifungal susceptibility testing is crucial in guiding the treatment approach, especially for species like C. lusitaniae that may exhibit variable resistance patterns 1.
From the FDA Drug Label
The following data are available, but their clinical significance is unknown At least 90 percent of the following fungi exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for voriconazole against isolates of similar genus or organism group However, the effectiveness of voriconazole in treating clinical infections due to these fungi has not been established in adequate and well-controlled clinical trials: Candida lusitaniae
- Antimicrobial Activity Voriconazole has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections... However, based on the information provided, Voriconazole is a potential option for treating Candida lusitaniae, but its effectiveness in clinical infections due to this fungus has not been established in adequate and well-controlled clinical trials 2.
- Key points:
- Voriconazole may be active against Candida lusitaniae in vitro
- The clinical significance of this activity is unknown
- The effectiveness of voriconazole in treating clinical infections due to Candida lusitaniae has not been established in adequate and well-controlled clinical trials
From the Research
Antifungal Options for Candida lusitaniae
The best antifungal for Candida lusitaniae is a subject of several studies, with various options being considered. Some of the key findings include:
- Amphotericin B has been shown to be effective against Candida lusitaniae, with fungicidal activity against most isolates 3.
- Voriconazole is also highly active against Candida lusitaniae, with all isolates being susceptible in one study 4.
- Fluconazole has been used to treat Candida lusitaniae infections, particularly in cases where the isolate is susceptible 5.
- Flucytosine has been shown to have variable activity against Candida lusitaniae, with some isolates being resistant 3, 6.
- Posaconazole has been shown to be active against Candida lusitaniae, with 94-100% of isolates being susceptible in one study 7.
Key Considerations
When choosing an antifungal for Candida lusitaniae, several factors should be considered, including:
- The susceptibility of the isolate to the antifungal agent
- The severity of the infection
- The patient's underlying health status
- The potential for resistance to develop
- The availability of the antifungal agent
Susceptibility Patterns
The susceptibility patterns of Candida lusitaniae to various antifungal agents are summarized below:
- Amphotericin B: highly active, with fungicidal activity against most isolates 3, 6
- Voriconazole: highly active, with all isolates being susceptible in one study 4
- Fluconazole: variable activity, with some isolates being resistant 5
- Flucytosine: variable activity, with some isolates being resistant 3, 6
- Posaconazole: highly active, with 94-100% of isolates being susceptible in one study 7