From the Guidelines
The recommended treatment for Candida parapsilosis infections typically involves echinocandins as first-line therapy, with fluconazole as an effective alternative. For invasive infections, micafungin (100 mg daily), caspofungin (70 mg loading dose, then 50 mg daily), or anidulafungin (200 mg loading dose, then 100 mg daily) are preferred initial treatments, as supported by the 2016 update by the Infectious Diseases Society of America 1. Fluconazole can be used at 800 mg loading dose followed by 400 mg daily for susceptible isolates.
Key Considerations
- Treatment duration generally ranges from 14 days for candidemia to several weeks for deep-seated infections, continuing for at least 14 days after the last positive blood culture and resolution of symptoms.
- Device removal (such as central venous catheters) is crucial when feasible, as C. parapsilosis has a strong ability to form biofilms on medical devices.
- Susceptibility testing is important since C. parapsilosis may show higher MICs to echinocandins compared to other Candida species, though clinical resistance remains uncommon, as noted in the clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America 1.
- For less severe infections like cutaneous candidiasis, topical azoles may be sufficient.
- The choice between echinocandins and fluconazole should consider the patient's prior antifungal exposure, severity of illness, and local resistance patterns, as recommended in the clinical practice guidelines 1.
From the FDA Drug Label
The overall clinical and mycological success rates by Candida species in Study 150 to 608 are presented in Table 15. Table 15: Overall Success Rates Sustained From EOT To The Fixed 12-Week Follow-Up Time Point By Baseline Pathogen *,† Baseline Pathogen Clinical and Mycological Success (%) Voriconazole Amphotericin B --> Fluconazole C. albicans 46/107 (43%) 30/63 (48%) C tropicalis 17/53 (32%) 1/16 (6%) C. parapsilosis 24/45 (53%) 10/19 (53%) C. glabrata 12/36 (33%) 7/21 (33%) C. krusei 1/4 0/1
The recommended treatment for Candida parapsilosis infections is voriconazole.
- The clinical and mycological success rate for C. parapsilosis was 53% for both voriconazole and amphotericin B followed by fluconazole.
- The dosage regimen for Candidemia in non-neutropenic patients and other deep tissue Candida infections is a loading dose of 6 mg/kg every 12 hours for the first 24 hours, followed by a maintenance dose of 3 to 4 mg/kg every 12 hours intravenously or 200 mg every 12 hours orally 2.
From the Research
Treatment Options for Candida parapsilosis Infections
- The recommended treatment for Candida parapsilosis infections is not universally agreed upon, but several studies suggest the use of echinocandins, such as micafungin, anidulafungin, and caspofungin 3, 4, 5.
- Micafungin has been shown to be effective against Candida parapsilosis, with a recommended dose of 100-150 mg/d 4.
- Anidulafungin and caspofungin have also been shown to be effective against Candida parapsilosis, with prolonged post-antifungal effects 3.
- Amphotericin B and fluconazole have also been used to treat Candida parapsilosis infections, particularly in cases of endocarditis 6, 7.
- The choice of treatment may depend on the severity of the infection, the patient's underlying health conditions, and the susceptibility of the Candida parapsilosis isolate to different antifungal agents.
Considerations for Treatment
- Candida parapsilosis has been shown to have lower susceptibility to echinocandins compared to other Candida species 5.
- Acquired resistance to echinocandins can occur in Candida parapsilosis, which may affect the efficacy of treatment 5.
- The use of combination therapy, such as liposomal amphotericin B and flucytosine, may be effective in treating Candida parapsilosis infections 6.
- Surgical intervention may be necessary in cases of prosthetic heart valve infective endocarditis caused by Candida parapsilosis 6.