What is the treatment for Candida glabrata (Candidiasis) infection?

From the Guidelines

The treatment of Candida glabrata infections typically requires echinocandins as first-line therapy due to this species' intrinsic resistance to azole antifungals.

Treatment Options

• Micafungin (100 mg IV daily), caspofungin (70 mg IV loading dose, then 50 mg IV daily), or anidulafungin (200 mg IV loading dose, then 100 mg IV daily) are the preferred initial treatments for 14 days or until clinical resolution, as recommended by the Infectious Diseases Society of America 1.
• For less severe infections, high-dose fluconazole (800 mg loading dose, then 400-800 mg daily) may be used if susceptibility is confirmed, although this is not the preferred initial treatment due to the risk of resistance 1.
• In cases of persistent or recurrent infections, amphotericin B (0.7-1 mg/kg/day) can be considered despite its toxicity profile, as an alternative to echinocandins 1.

Important Considerations

• Treatment duration should be individualized based on clinical response, with invasive infections requiring longer courses 1.
• Source control through removal of infected catheters or drainage of abscesses is crucial for successful treatment 1.
• C. glabrata's increasing resistance patterns make susceptibility testing important for guiding therapy, as this species forms biofilms and can develop resistance during treatment, particularly in immunocompromised patients or those with prior azole exposure 1.

From the FDA Drug Label

For adult patients with candidemia, the recommended dose is 6 mg/kg every 12 hours for the first 24 hours, followed by 3 to 4 mg/kg every 12 hours. In clinical trials, patients with candidemia received 3 mg/kg intravenous infusion every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg every 12 hours as salvage therapy.

The treatment for Candida glabrata (Candidiasis) infection is voriconazole administered as follows:

• Loading dose: 6 mg/kg every 12 hours for the first 24 hours
• Maintenance dose: 3 to 4 mg/kg every 12 hours Alternatively, micafungin can be used at a dose of 100 mg/day. 2 3

From the Research

Treatment Options for Candida glabrata Infection

• Micafungin is an effective treatment for multi-drug resistant Candida glabrata urosepsis, as shown in a case report 4.
• Micafungin results in similar outcomes to comparators for candidaemia/invasive candidiasis due to C. glabrata and C. krusei, with a 100 mg/day dose being an acceptable option 5.
• Echinocandins, such as caspofungin, are recommended as first-line agents against invasive fungal infections caused by Candida glabrata, but dose escalation may not improve efficacy 6.
• The optimal regimen for the treatment of invasive Candida glabrata infections in neutropenic patients is not known, but higher dosages of echinocandins may be required to induce fungicidal effects 7.
• Echinocandin resistance among C. glabrata isolates is a concern, with 3.1-3.6% of isolates being resistant to anidulafungin, caspofungin, and micafungin, and 36% of resistant isolates also being resistant to fluconazole 8.

Factors Affecting Treatment Outcomes

• Patient characteristics, such as neutropenia and severity of illness, can affect clinical outcomes 5.
• Catheter management is also an important factor in affecting clinical outcomes 5.
• The presence of FKS mutations in C. glabrata isolates can lead to echinocandin resistance and multidrug resistance 8.

Dosage and Administration

• Micafungin can be administered at a dose of 100 mg/day, with the option for dose escalation 4, 5.
• Caspofungin can be administered at doses of 1-20 mg/kg daily, but dose escalation may not improve efficacy 6.
• Higher dosages of echinocandins may be required to induce fungicidal effects in neutropenic hosts 7.