How is a groin fungal infection managed in a patient taking Jardiance (empagliflozin)?

Management of Groin Fungal Infection in Patients Taking Jardiance (Empagliflozin)

For patients taking Jardiance (empagliflozin) who develop a groin fungal infection, treatment with oral fluconazole 200 mg daily for 2 weeks is the recommended first-line therapy, along with temporary discontinuation of Jardiance until the infection resolves. 1, 2

Understanding the Risk

• SGLT2 inhibitors like Jardiance significantly increase the risk of genital mycotic infections, occurring in 3.7-4.1% of patients compared to 0.9% in placebo groups 2
• Women are at higher risk (13.2% vs 3.3% in men) for developing genital fungal infections when taking SGLT2 inhibitors 3
• Prior history of genital fungal infection is a significant risk factor, with 21.6% of those with previous infections developing recurrence on SGLT2 inhibitor therapy 3

Diagnostic Approach

• Visual examination of the affected area to confirm fungal infection (typically presents as erythematous, pruritic rash with satellite lesions in the groin) 1
• Consider fungal culture in recurrent or treatment-resistant cases to identify specific species 1
• Assess for extent of infection and rule out more severe complications such as Fournier's gangrene, which though rare, has been reported with empagliflozin use 4, 5

Treatment Algorithm

Step 1: Initial Management

• For uncomplicated groin fungal infection:
  • Oral fluconazole 200 mg daily for 2 weeks is the first-line treatment 1
  • Temporarily discontinue Jardiance until infection resolves 2, 4

Step 2: For Fluconazole-Resistant Species

• If C. glabrata is suspected or confirmed:
  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days OR
  • Oral flucytosine 25 mg/kg four times daily for 7-10 days 1
• If C. krusei is suspected or confirmed:
  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1

Step 3: Adjunctive Measures

• Eliminate predisposing factors when possible 1
• Ensure proper hygiene and keep the affected area clean and dry 1
• Consider topical antifungal agents as adjunctive therapy 1

Special Considerations

• Monitor for improvement within 1 week of treatment initiation 1
• For recurrent infections, consider prophylactic antifungal therapy while on Jardiance 1
• For patients with diabetes, optimize glycemic control as hyperglycemia promotes fungal growth 1, 2

When to Consider Alternative Diabetes Medication

• In patients with multiple recurrent fungal infections despite appropriate treatment 4
• In patients who develop severe infections such as Fournier's gangrene 4, 5
• In patients with other risk factors for severe infection (immunosuppression, poor hygiene) 5

Prevention Strategies

• Patient education on proper hygiene 1
• Regular monitoring for symptoms of genital infections, especially in high-risk patients (women, those with prior fungal infections) 3
• Early intervention at first signs of infection 1, 2

Potential Complications

• If left untreated, simple fungal infections can potentially progress to more severe infections 4
• Rare but serious complication is Fournier's gangrene, which requires immediate surgical intervention and broad-spectrum antibiotics 4, 5
• Recurrent infections may impact medication adherence and quality of life 3