From the Guidelines
For Candida glabrata urinary tract infections (UTIs), fluconazole should be avoided due to high resistance rates, and first-line treatment is an echinocandin such as micafungin 100mg IV daily, caspofungin 70mg IV loading dose followed by 50mg daily, or anidulafungin 200mg IV loading dose followed by 100mg daily for 7-14 days. The treatment of Candida glabrata UTIs requires careful consideration of the antifungal resistance patterns and the ability of the antifungal agent to achieve adequate concentrations in the urine 1. According to the 2016 clinical practice guideline for the management of candidiasis, fluconazole-susceptible organisms can be treated with oral fluconazole, but fluconazole-resistant C. glabrata requires alternative treatments such as AmB deoxycholate or oral flucytosine 2. Some key points to consider in the treatment of Candida glabrata UTIs include:
- Removal of an indwelling bladder catheter, if feasible, is strongly recommended 2
- AmB deoxycholate bladder irrigation may be useful for treatment of cystitis due to fluconazole-resistant species, such as C. glabrata and C. krusei 2
- Treatment duration depends on severity, with 7 days for uncomplicated cases and 14 days for complicated infections
- Monitoring renal function is essential with amphotericin B and flucytosine
- Follow-up cultures should be obtained to confirm eradication, especially in complicated cases It's worth noting that the evidence for the treatment of Candida glabrata UTIs is based on the 2016 clinical practice guideline for the management of candidiasis, which provides strong recommendations for the treatment of fluconazole-susceptible and fluconazole-resistant organisms 2, 1. However, the use of echinocandins, such as micafungin, caspofungin, and anidulafungin, is also supported by other studies, including the 2009 clinical practice guidelines for the management of candidiasis 3, 4. Overall, the treatment of Candida glabrata UTIs requires a careful consideration of the antifungal resistance patterns, the ability of the antifungal agent to achieve adequate concentrations in the urine, and the severity of the infection.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Candida glabrata Urinary Tract Infection (UTI)
- Micafungin has been shown to be an effective treatment for Candida glabrata UTI, including cases with multi-drug resistance 5, 6.
- Caspofungin, another echinocandin, has also been used to treat Candida glabrata UTI, but its effectiveness may be limited in complicated cases such as obstructive pyonephrosis 7, 8.
- The use of echinocandins, such as caspofungin and micafungin, is generally recommended for the treatment of Candida glabrata infections due to the high rate of resistance to fluconazole 9.
- However, the development of resistance to echinocandins is a concern, and FKS mutations have been identified as a major mechanism of echinocandin resistance in Candida glabrata 9.
- In cases where echinocandins are not effective, alternative treatments such as amphotericin B may be necessary, and percutaneous drainage and local instillation of antifungal agents may be required for complicated cases 7.