From the Guidelines
The recommended treatment for Candida glabrata urinary tract infections (UTIs) is oral fluconazole, 200 mg (3 mg/kg) daily for 2 weeks for fluconazole-susceptible organisms, while for fluconazole-resistant C. glabrata, AmB deoxycholate, 0.3–0.6 mg/kg daily for 1–7 days or oral flucytosine, 25 mg/kg 4 times daily, is recommended. When considering treatment options, it's crucial to prioritize the management of underlying conditions and the removal or replacement of urinary catheters if present, as these can contribute to the development and persistence of the infection 1. Key considerations in the treatment approach include:
- The use of antifungal susceptibility testing to guide therapy whenever possible, due to varying resistance patterns 1.
- The management of underlying conditions such as diabetes and the reduction of immunosuppressive medications if feasible.
- The potential use of AmB deoxycholate bladder irrigation for patients with fungal balls or those who cannot tolerate systemic therapy, although this is based on low-quality evidence 1. Given the potential for fluconazole resistance in C. glabrata, fluconazole is generally not the first-line treatment, and alternative antifungal agents such as AmB deoxycholate or oral flucytosine are preferred for fluconazole-resistant strains 1. Follow-up cultures are essential to confirm the eradication of the infection, particularly in complicated cases or immunocompromised patients.
From the Research
Treatment Options for Candida glabrata UTIs
- The recommended treatment for Candida glabrata urinary tract infections (UTIs) is fluconazole, with a dosage of 400 mg on day 1 and 200 mg daily for 7 to 14 days for cystitis 2.
- In cases of pyelonephritis without associated candidemia, the first-line therapy is fluconazole (3-6 mg/kg/day) for 14 days or amphotericin B at a dose of 0.5 to 0.7 mg/kg/day with or without flucytosine when potentially resistant strain (C. glabrata) 2.
- Micafungin, an echinocandin, has been shown to be effective in treating C. glabrata-associated urinary tract infections, especially in cases where the organism is resistant to fluconazole 3.
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 4.
Considerations for Treatment
- The choice of antifungal agent depends on the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the agent 5.
- In cases of obstructive pyonephrosis, treatment with intravenous antifungal agents such as caspofungin may not be sufficient, and percutaneous drainage and instillation of amphotericin B deoxycholate into the renal pelvis may be necessary 6.
- The presence of Candida species in urine in asymptomatic patients does not warrant antifungal therapy, except in certain cases such as neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures 4.