From the Guidelines
Echinocandins are the top medications for Candida glabrata, with options including caspofungin, micafungin, and anidulafungin, due to their strong fungicidal activity against this species 1.
Key Medications for Candida glabrata
- Echinocandins:
- Caspofungin: loading dose 70 mg, then 50 mg daily
- Micafungin: 100 mg daily
- Anidulafungin: loading dose 200 mg, then 100 mg daily
- Fluconazole: 800-mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg) daily, but only for fluconazole-susceptible isolates
- Voriconazole: 200–300 (3–4 mg/kg) twice daily, but only for voriconazole-susceptible isolates
- Lipid formulation AmB: 3–5 mg/kg daily, as an alternative if there is intolerance, limited availability, or resistance to other antifungal agents
These recommendations are based on strong evidence from clinical practice guidelines, which emphasize the importance of selecting antifungal therapy based on the specific Candida species and its susceptibility profile 1.
From the Research
Top Medications for Candida glabrata
The following medications have been studied for the treatment of Candida glabrata:
- Fluconazole: a viable therapy for C. glabrata fungemia, with bloodstream eradication in 65% of patients and mortality rates of 24% to 40% 2
- Echinocandins: typically the first-line therapy for C. glabrata candidaemia, with the option to transition to oral fluconazole 3
- Voriconazole: biguanides, such as metformin, can enhance the activity of voriconazole against C. glabrata 4
- Amphotericin B: can be used in combination with fluconazole for the treatment of C. glabrata fungemia 2
- Metformin: a biguanide with antifungal activity against C. glabrata, which can also enhance the activity of other antifungal drugs 4
- Silver nanoparticles: can enhance the efficacy of fluconazole against C. glabrata by reversing the resistance of fungal cells to fluconazole 5
Combination Therapies
Combination therapies have been studied for the treatment of C. glabrata, including:
- Fluconazole and amphotericin B: can be used in combination for the treatment of C. glabrata fungemia 2
- Biguanides and antifungal drugs: biguanides, such as metformin, can enhance the activity of antifungal drugs, including voriconazole, fluconazole, and amphotericin, against C. glabrata 4
- Fluconazole step-down therapy: can be used after initial treatment with echinocandins for the treatment of C. glabrata candidaemia 3