What is the recommended treatment for Candida albicans infections?

From the Guidelines

The recommended treatment for Candida albicans infections is an echinocandin, such as caspofungin, micafungin, or anidulafungin, as initial therapy, with fluconazole being an acceptable alternative in selected patients 1.

Treatment Options

• Echinocandins: caspofungin (loading dose 70 mg, then 50 mg daily), micafungin (100 mg daily), or anidulafungin (loading dose 200 mg, then 100 mg daily) are recommended as initial therapy for Candida albicans infections 1.
• Fluconazole: 800-mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg) daily is an acceptable alternative to an echinocandin as initial therapy in selected patients, including those who are not critically ill and who are considered unlikely to have a fluconazole-resistant Candida species 1.

Special Considerations

• Testing for azole susceptibility is recommended for all bloodstream and other clinically relevant Candida isolates 1.
• Transition from an echinocandin to fluconazole is recommended for patients who are clinically stable, have isolates that are susceptible to fluconazole, and have negative repeat blood cultures following initiation of antifungal therapy 1.
• Lipid formulation amphotericin B (3–5 mg/kg daily) is a reasonable alternative if there is intolerance, limited availability, or resistance to other antifungal agents 1.

Duration of Therapy

• The recommended duration of therapy for candidemia without obvious metastatic complications is for 2 weeks after documented clearance of Candida species from the bloodstream and resolution of symptoms attributable to candidemia 1.

From the FDA Drug Label

Oropharyngeal candidiasis: The recommended dosage of DIFLUCAN for oropharyngeal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Esophageal candidiasis: The recommended dosage of DIFLUCAN for esophageal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Systemic Candida infections: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia, optimal therapeutic dosage and duration of therapy have not been established.

The recommended treatment for Candida albicans infections depends on the type and severity of the infection.

• For oropharyngeal candidiasis, the recommended dosage is 200 mg on the first day, followed by 100 mg once daily.
• For esophageal candidiasis, the recommended dosage is 200 mg on the first day, followed by 100 mg once daily.
• For systemic Candida infections, the optimal therapeutic dosage and duration of therapy have not been established, but doses up to 400 mg daily have been used in open, noncomparative studies of small numbers of patients 2.

From the Research

Treatment Options for Candida albicans Infections

• The recommended treatment for Candida albicans infections is fluconazole, which has been shown to be effective in various studies 3, 4, 5, 6.
• Fluconazole is a well-tolerated and effective agent for the treatment of systemic Candida albicans infections, with a clinical and mycological response achieved in 62% and 65% of patients, respectively 3.
• The dosage of fluconazole varies from 50 to 400 mg daily, with a median duration of treatment of 21 days 7.
• In patients with proven or probable Candida albicans infections, fluconazole treatment was successful in 53% of patients, with a clinical response rate of 60% in the 5 mg/kg once daily group and 83% in the group which received 10 mg/kg/day 6.
• Fluconazole is also effective against non-albicans Candida species, although higher doses may be required for infections caused by Candida glabrata 7.
• However, Candida krusei is intrinsically resistant to fluconazole, and other species, notably Candida glabrata, often manifest reduced susceptibility 5.

Efficacy and Tolerability of Fluconazole

• Fluconazole exhibits predictable pharmacokinetics and an excellent tolerance profile in all groups, including the elderly and children 4, 5.
• The most common adverse effects of fluconazole are raised concentrations of liver enzymes, fatigue, nausea, gastric pain, sleepiness, and epileptic seizure 6.
• Fluconazole is a fungistatic drug against yeasts and lacks activity against moulds 5.
• The emergence of azole-resistant strains has raised important questions about the use of fluconazole as a first-line drug 5.

Clinical Applications of Fluconazole

• Fluconazole is still a major drug for antifungal prophylaxis in the setting of transplantation, intensive care unit, and in neutropenic patients 5.
• Prophylactic fluconazole still has a place in HIV-positive patients in viro-immunological failure with recurrent mucosal candidiasis 5.
• Fluconazole can be used in adult neutropenic patients with systemic candidiasis, as long as the species identified is a priori susceptible 5.
• Among non-neutropenic patients with candidaemia, fluconazole is one of the first-line drugs for susceptible species 5.