What is the treatment for Candida glabrata infection?

From the Guidelines

Candida glabrata infections should be treated with an echinocandin, such as caspofungin, micafungin, or anidulafungin, as initial therapy due to the high-quality evidence supporting their effectiveness 1. The recommended dosages for these medications are: caspofungin (loading dose 70 mg, then 50 mg daily), micafungin (100 mg daily), or anidulafungin (loading dose 200 mg, then 100 mg daily) 1. Some key points to consider when treating Candida glabrata infections include:

• Testing for azole susceptibility is recommended for all bloodstream and other clinically relevant Candida isolates 1
• Transition to fluconazole can be considered for patients who are clinically stable and have isolates that are susceptible to fluconazole 1
• For infection due to C. glabrata, transition to higher-dose fluconazole or voriconazole should only be considered among patients with fluconazole-susceptible or voriconazole-susceptible isolates 1
• Lipid formulation AmB is a reasonable alternative if there is intolerance, limited availability, or resistance to other antifungal agents 1 The treatment duration generally ranges from 14 to 21 days, depending on the severity and site of infection 1. It is essential to note that Candida glabrata has intrinsic reduced susceptibility to azoles, and source control through removal of infected catheters or drainage of abscesses is crucial for successful treatment 1. Regular monitoring of liver and kidney function is necessary during antifungal therapy to detect potential medication toxicity 1.

From the FDA Drug Label

Table 15: Overall Success Rates Sustained From EOT To The Fixed 12-Week Follow-Up Time Point By Baseline Pathogen C. glabrata 12/36 (33%) 7/21 (33%) The treatment for Candida glabrata infection is voriconazole with a success rate of 33% 2.

From the Research

Treatment Options for Candida glabrata Infection

• Echinocandins are typically the first-line therapy for C. glabrata candidaemia, with the option to transition to oral fluconazole 3.
• Fluconazole appears to be a safe and reasonable step-down therapy in the management of C. glabrata candidaemia 3.
• Micafungin, an echinocandin, has been shown to be effective in treating C. glabrata infections, including chronic recurrent vulvovaginal candidiasis 4, 5.
• The choice of antifungal therapy, including fluconazole or an echinocandin, can predict response in patients with C. glabrata fungaemia, but does not influence mortality 6.

Echinocandin Resistance

• Echinocandin resistance among C. glabrata isolates is a concern, with 3.1-3.6% of isolates resistant to anidulafungin, caspofoun, or micafungin 7.
• Mutations in the FKS1 and FKS2 genes are a major mechanism of echinocandin resistance in C. glabrata 7.
• Isolates with FKS mutations are often resistant to at least one echinocandin, and may also be resistant to fluconazole, resulting in multidrug resistance 7.

Antifungal Therapy

• The dose:MIC ratio of fluconazole is important in predicting response, with a ratio >12.5 associated with a higher day 14 complete response 6.
• Micafungin has been shown to be noninferior to caspofoun, liposomal amphotericin B, and fluconazole in treating invasive and oesophageal candidiasis 5.
• Micafungin is generally well tolerated, with a similar tolerability profile to caspofoun and fluconazole 5.