What are the antibiotics (Abx) for treating Candida infections?

From the Guidelines

Antifungal medications, not antibiotics, are used to treat Candida infections, with echinocandins being the preferred first-line treatment for invasive or resistant infections. The treatment of Candida infections typically involves the use of antifungal medications, and the choice of medication depends on the severity and location of the infection, as well as the specific Candida species involved.

• For non-neutropenic adults with candidemia, echinocandins, such as caspofungin (70mg loading dose, then 50mg daily) or micafungin (100-150mg daily), are strongly recommended as initial therapy 1.
• Liposomal amphotericin B and voriconazole are also supported as alternative therapies, with fluconazole being recommended for patients who are not critically ill and have had no prior azole exposure 1.
• The treatment duration for candidemia should be a minimum of 14 days after the end of candidaemia, and removal of indwelling catheters is strongly recommended 1.
• For patients with invasive or resistant infections, echinocandins or liposomal amphotericin B are preferred over azoles 1.
• Topical options, such as clotrimazole, miconazole, or nystatin, can be used for localized skin or mucosal infections.
• The selection of antifungal medication should consider the specific Candida species, infection site, patient factors, and local resistance patterns, as some species like C. glabrata and C. auris show increasing resistance to fluconazole 1.

From the FDA Drug Label

The primary analysis, which counted DRC-assessed successes at the fixed time point (12 weeks after End of Therapy [EOT]), demonstrated that voriconazole was comparable to the regimen of amphotericin B followed by fluconazole (response rates of 41% and 41%, respectively) in the treatment of candidemia. Fluconazole has been shown to be active against most isolates of the following microorganisms both in vitro and in clinical infections Candida albicans Candida glabrata (Many isolates are intermediately susceptible) Candida parapsilosis Candida tropicalis

Antibiotics (Abx) for treating Candida infections are actually antifungals, not antibiotics.

• Voriconazole and fluconazole are two such antifungals.
• Voriconazole was comparable to the regimen of amphotericin B followed by fluconazole in the treatment of candidemia.
• Fluconazole is active against most isolates of Candida albicans, Candida glabrata, Candida parapsilosis, and Candida tropicalis. However, Candida krusei should be considered to be resistant to fluconazole 2. In the case of Candida krusei, alternative antifungal therapy may be required 2. It's also worth noting that voriconazole was evaluated in 35 patients with deep tissue Candida infections, and a favorable response was seen in some of these patients 3.

From the Research

Antibiotics for Candida Infections

• The term "antibiotics" typically refers to drugs used to treat bacterial infections, but in the context of treating Candida infections, antifungal medications are used instead.
• For Candida infections, fluconazole is a commonly used antifungal drug, as seen in studies 4, 5, 6, 7, 8.
• Fluconazole has been shown to be effective against various Candida species, including Candida albicans, Candida parapsilosis, and Candida tropicalis, although its efficacy against Candida glabrata may be lower and require higher doses 4, 5.
• The dosage of fluconazole can vary, with studies using doses ranging from 50 to 400 mg daily, and in some cases, up to 800 mg/day or more in intensive care settings 4, 7.
• Fluconazole is generally well-tolerated, with a good safety profile, even at high doses 6, 7.
• Other antifungal drugs, such as amphotericin B, may also be used to treat Candida infections, especially in severe cases or when fluconazole is not effective 4, 8.

Specific Candida Species and Treatment

• Candida krusei is inherently resistant to fluconazole and should not be treated with this drug 4, 6.
• Candida glabrata may exhibit reduced susceptibility to fluconazole, requiring higher doses or alternative treatments 4, 6.
• The choice of antifungal medication and dosage may depend on the specific Candida species, the severity of the infection, and the patient's underlying health conditions 6, 7.