Treatment of Candida glabrata Vaginal Infection
For Candida glabrata vulvovaginitis, topical intravaginal boric acid administered in a gelatin capsule, 600 mg daily for 14 days is the recommended first-line treatment. 1
First-line Treatment Options
- Topical intravaginal boric acid in a gelatin capsule, 600 mg daily for 14 days, is the recommended first-line treatment for C. glabrata vulvovaginitis, especially when oral azoles are ineffective 1
- C. glabrata infections are considered "complicated" vulvovaginal candidiasis and require specific treatment approaches different from those used for C. albicans 1
Alternative Treatment Options
- Nystatin intravaginal suppositories, 100,000 units daily for 14 days, can be used as an alternative treatment for C. glabrata infection 1
- Topical 17% flucytosine cream alone or in combination with 3% AmB cream administered daily for 14 days is another option, though this is a weaker recommendation 1
Treatment Considerations
- C. glabrata often demonstrates resistance to azole antifungals, including fluconazole, making standard treatments for C. albicans ineffective 1, 2
- In a comparative study of diabetic patients with C. glabrata vulvovaginal candidiasis, boric acid vaginal suppositories showed significantly higher mycological cure rates (63.6%) compared to oral fluconazole (28.6%) 2
- Treatment should continue for the full 14-day course to ensure complete eradication of the infection 1
For Recurrent Infections
- For recurring vulvovaginal candidiasis, 10-14 days of induction therapy with a topical agent should be followed by a maintenance regimen 1
- After the initial treatment course, consider maintenance therapy if recurrence is a concern 1, 3
- In cases of persistent infection despite standard therapy, voriconazole has been reported as a potential treatment option in case studies 4
Diagnostic Confirmation
- Before initiating treatment, confirm the diagnosis through wet-mount preparation with saline and 10% potassium hydroxide to demonstrate yeast or hyphae 1, 5
- Vaginal cultures should be obtained for those with negative microscopy findings to identify the specific Candida species 1, 5
- A normal vaginal pH (4.0-4.5) should be verified before starting treatment 1, 5
Treatment Monitoring and Follow-up
- Patients should be instructed to return for follow-up visits if symptoms persist or recur after completing the treatment course 1
- Clinical response should be evaluated after completing the 14-day treatment regimen 1
- If symptoms persist despite appropriate therapy, consider alternative diagnoses or resistant infection 1
Special Considerations
- Oil-based creams and suppositories might weaken latex condoms and diaphragms, so patients should be advised about potential contraceptive failure 1
- Boric acid should never be taken orally as it is toxic if ingested 2
- Treatment approach should not differ based on HIV status, with identical response rates expected in both HIV-positive and HIV-negative women 1