From the Guidelines
Resistant candidiasis (thrush) treatment involves a multi-step approach. The first line of treatment for uncomplicated candidiasis is usually a topical or oral antifungal agent, such as fluconazole, which achieves a >90% response rate 1.
Treatment Options
- Topical agents: Effective for uncomplicated infections, with no evidence of superiority of one regimen over another 1.
- Oral fluconazole: Can be used as a single dose or for 3 days, with a >90% response rate 1.
- Intravaginal topical agents: Used for 5-7 days for complicated infections, or oral fluconazole 150 mg every 72 hours for 3 doses 1.
Resistant Species
- C. krusei: Responds to all topical antifungal agents, but not to fluconazole 1.
- C. glabrata: Treatment is problematic, with azole therapy often unsuccessful; local regimens such as boric acid or nystatin may be effective 1.
Recurrent Infections
- Induction therapy: With a topical agent or oral fluconazole for 10-14 days, followed by a maintenance azole regimen for at least 6 months 1.
- Maintenance therapy: 150 mg fluconazole once weekly, which achieves control of symptoms in >90% of patients 1.
From the Research
Treatment Options for Resistant Candidiasis
The treatment of resistant candidiasis, also known as thrush, is a complex issue due to the increasing incidence of drug-resistant Candida species 2. The main classes of antifungals used to treat invasive candidiasis are azoles, echinocandins, and polyenes, but resistance to these drugs is becoming more common 2, 3.
Mechanisms of Resistance
The mechanisms of resistance to antifungal drugs in Candida species include increased drug efflux, alteration or increase in the drug target, and development of compensatory pathways for producing the target sterol, ergosterol 4. Additionally, DNA mismatch repair gene mutations may facilitate the acquisition of resistance mutations in certain Candida species, such as C. glabrata 3.
Strategies to Combat Resistance
To combat the threat of emerging resistance in Candida, several strategies can be employed, including:
- Avoiding antifungal overuse and selecting the best drug, dose, and duration when needed 2
- Implementing antifungal stewardship programs to reduce unnecessary use of antifungals 2, 3
- Using combination therapy between conventional and repurposed agents 5
- Conducting microbiological diagnosis to the species level and using susceptibility tests to guide treatment decisions 2
Current Therapeutic Approaches
Current therapeutic approaches for the treatment of resistant candidiasis include the use of novel antifungal agents and targets in pre-clinical and clinical development, as well as the use of traditional antifungal drugs in combination with other agents 5, 6. However, the effectiveness of these approaches depends on various factors, including the species of Candida, the mechanism of resistance, and the severity of the infection.