What is the treatment for Candida (fungal infection) in stool?

From the Guidelines

For the treatment of Candida in stool, fluconazole is an appropriate choice if Candida albicans is isolated, as recommended by the guidelines 1. When it comes to treating Candida infections in the stool, the primary goal is to eliminate the fungal overgrowth while minimizing harm and promoting a healthy gut microbiota.

Key Considerations

• The choice of antifungal therapy depends on the severity of the infection and the specific species of Candida isolated.
• For fluconazole-resistant Candida species, therapy with an echinocandin (such as caspofungin, micafungin, or anidulafungin) is recommended 1.
• In critically ill patients, initial therapy with an echinocandin instead of a triazole is suggested due to its broader coverage and potentially lower risk of resistance 1.

Treatment Approach

• Fluconazole at an appropriate dose is often the first-line treatment for Candida albicans infections, given its efficacy and relatively favorable side effect profile 1.
• Dietary changes, including a low-sugar, anti-inflammatory diet that eliminates refined carbohydrates and added sugars, can help support treatment by favoring the growth of healthy gut flora.
• Increasing intake of probiotic-rich foods or taking probiotic supplements containing beneficial strains like Lactobacillus and Bifidobacterium can also aid in restoring the balance of gut microbiota.

Special Populations

• In neonates, empiric antifungal therapy should be started if Candida is suspected, with fluconazole being an appropriate choice if C. albicans is isolated 1.
• The treatment approach may need to be adjusted in immunocompromised individuals or those with certain underlying conditions that predispose them to recurrent fungal infections.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Candida Infection in Stool

• The treatment for Candida infection in stool typically involves antifungal medications, such as nystatin 2 and fluconazole 3.
• A study published in 2018 found that patients who adhered to a diet modification during and after treatment with nystatin had better outcomes for intestinal Candida overgrowth 2.
• Another study published in 2022 found that oral fluconazole therapy reduced disease activity in patients with active ulcerative colitis who had detectable Candida in their stool 3.
• Other antifungal agents, such as anidulafungin 4, itraconazole, voriconazole, and posaconazole, may also be effective in treating Candida infections 5.
• The choice of antifungal agent depends on the severity of the infection, the patient's overall health, and the presence of any underlying medical conditions 6.

Antifungal Medications

• Nystatin is a commonly used topical antifungal medication for treating oral candidiasis 5.
• Fluconazole is an oral antifungal medication that can be used to treat oral candidiasis that does not respond to topical treatment 5.
• Anidulafungin is an intravenous antifungal medication that has been shown to be effective in treating invasive candidiasis 4.
• Other antifungal medications, such as miconazole, amphotericin B, and clotrimazole, may also be used to treat Candida infections 5.

Diet Modification

• A study published in 2018 found that diet modification during and after treatment with nystatin improved outcomes for intestinal Candida overgrowth 2.
• The study suggested that diet modification could reduce the need for excessive prescription of antifungals 2.
• However, more research is needed to fully understand the role of diet modification in treating Candida infections.