What is the treatment for Jarduance (generic name unknown) induced fungal infection?

Treatment for Jardiance-Induced Fungal Infection

Fluconazole 200 mg (3 mg/kg) daily for 2 weeks is the recommended treatment for Jardiance-induced fungal infection, which is likely a form of symptomatic candidiasis. 1

Diagnosis and Assessment

• Before initiating treatment, confirm the diagnosis through appropriate cultures from the affected site to identify the specific fungal pathogen 1
• Jardiance (empagliflozin) is an SGLT2 inhibitor that can increase the risk of genital mycotic infections due to increased urinary glucose excretion 2
• Most Jardiance-induced fungal infections are caused by Candida species, particularly Candida albicans 1
• Assess the severity and extent of the infection to determine appropriate treatment approach 1

Treatment Algorithm

First-Line Treatment

• For symptomatic candidiasis (most common Jardiance-induced fungal infection):
  • Fluconazole 200 mg (3 mg/kg) daily for 2 weeks 1
  • For extensive or severe infections, consider fluconazole 150-200 mg once daily for 2-4 weeks 2

Alternative Treatments (if fluconazole resistance is suspected or confirmed)

• Amphotericin B deoxycholate (AmB-d) 0.3-0.6 mg/kg for 1-7 days 1
• Flucytosine 25 mg/kg four times daily for 7-10 days 1
• For resistant organisms (e.g., Candida krusei and Candida glabrata), AmB-d bladder irrigation may be considered 1

For Severe or Systemic Infections

• If the infection has spread beyond local tissues or the patient is critically ill:
  • An echinocandin (caspofungin, micafungin, or anidulafungin) is preferred 1, 3
  • Caspofungin: 70 mg loading dose on day 1, followed by 50 mg daily 3
  • Micafungin: 100 mg daily 3
  • Anidulafungin: 200 mg loading dose, then 100 mg daily 3

Special Considerations

• For patients with renal impairment, dose adjustment of fluconazole may be necessary 1
• Eliminate predisposing factors when possible, including temporary discontinuation of Jardiance if infection is severe 1
• For recurrent infections, consider prophylactic antifungal therapy while continuing Jardiance 2
• Monitor for potential drug interactions, especially if the patient is on multiple medications 4
• For patients with diabetes, ensure adequate glycemic control as high blood glucose levels can worsen fungal infections 3

Duration of Treatment and Follow-up

• Treat for at least 14 days for symptomatic infections 1
• Continue treatment until complete resolution of symptoms 1
• For recurrent infections, consider longer duration of therapy and investigation of underlying factors 2
• Follow-up within 1-2 weeks after completing therapy to ensure resolution 1

Common Pitfalls and Caveats

• Failure to identify the causative organism can lead to inappropriate treatment selection 1
• Long-term azole use can cause hepatotoxicity and hormone-related effects; monitor for adverse effects 4
• Inadequate duration of therapy is a common cause of treatment failure and recurrence 1
• Continuing Jardiance without addressing the fungal infection may lead to persistent or recurrent infections 2
• Not eliminating predisposing factors (e.g., tight clothing, poor hygiene) can contribute to treatment failure 1

By following this treatment approach, most Jardiance-induced fungal infections can be effectively managed while allowing patients to continue their diabetes therapy if appropriate.