From the Guidelines
Echinocandins are the top medications for treating intestinal candidiasis caused by Candida glabrata.
Key Points
- The recommended initial therapy for intestinal candidiasis caused by Candida glabrata is an echinocandin, such as caspofungin, micafungin, or anidulafungin 1.
- Echinocandins have significant fungicidal activity against most Candida species, including C. glabrata, and have demonstrated success in approximately 70%–75% of patients in randomized, comparative clinical trials 1.
- Fluconazole is not recommended as initial therapy for C. glabrata infections due to its limited activity against this species, but it can be considered for step-down therapy in patients who are clinically stable and have isolates that are susceptible to fluconazole 1.
- Voriconazole is an alternative option for patients who have fluconazole-resistant isolates of C. glabrata that are voriconazole susceptible, but it is not recommended as initial therapy due to its limited availability and potential toxicity 1.
- Lipid formulation amphotericin B (LFAmB) is a reasonable alternative for patients who are intolerant to echinocandins or have refractory infections, but it is not recommended as first-line therapy due to its potential toxicity and limited availability 1.
Medication Dosages
- Caspofungin: loading dose of 70 mg, then 50 mg daily 1
- Micafungin: 100 mg daily 1
- Anidulafungin: loading dose of 200 mg, then 100 mg daily 1
- Fluconazole: loading dose of 800 mg, then 400 mg daily 1
- Voriconazole: 400 mg twice daily for 2 doses, then 200 mg twice daily 1
- LFAmB: 3-5 mg/kg daily 1
From the Research
Treatment Options for Intestinal Candidiasis caused by Candida glabrata
The following medications have been studied for the treatment of intestinal candidiasis caused by Candida glabrata:
- Fluconazole: effective in 50% of cases, with higher doses potentially required 2
- Echinocandins: typically used as first-line therapy, with the option to transition to oral fluconazole 3
- Micafungin: a new echinocandin drug with a wide antifungal spectrum, including rare Candida species 4
- Amphotericin B: often required for the treatment of C. glabrata infections, especially in cases of azole resistance 5
- Flucytosine: may be used in combination with other antifungal agents for the treatment of C. glabrata infections 5
Comparison of Treatment Outcomes
Studies have compared the efficacy of different treatment regimens for C. glabrata infections:
- Fluconazole step-down therapy versus echinocandins: no significant difference in treatment duration, incidence of persistent candidaemia, or 30-day clinical failure 3
- Micafungin in combination with topical ciclopirox olamine: successful treatment of chronic recurrent vulvovaginal candidiasis caused by C. glabrata 4
Limitations of Current Treatment Options
The emergence of pan-drug-resistant C. auris strains highlights the need for further development of diagnostic and therapeutic methods 6 Current treatment options are limited to four classes of systemic antifungals, with azoles and echinocandins being the most widely used 6