Treatment of Candida glabrata Vaginitis

Introduction to Treatment

The American College of Obstetricians and Gynecologists recommends intravaginal boric acid 600 mg daily for 14-21 days as the first-line treatment for vaginal candidiasis caused by Candida glabrata, with intravaginal nystatin suppositories or topical 17% flucytosine cream as alternative options 1

The Centers for Disease Control and Prevention suggests that C. glabrata requires non-azole intravaginal agents, as it is inherently resistant to standard azole therapy, unlike uncomplicated candidiasis caused by C. albicans which responds to short-course azoles in 80-90% of cases 2, 3
The Infectious Diseases Society of America recommends against using standard azole therapy for confirmed C. glabrata infections, as recent evidence shows high azole resistance rates in C. glabrata, with itraconazole resistance reaching 81% and fluconazole resistance at 31% 1, 2, 3

The American College of Obstetricians and Gynecologists recommends intravaginal boric acid 600 mg capsules daily for 14-21 days as the first-line treatment for C. glabrata vaginitis 1
The Centers for Disease Control and Prevention suggests topical 17% flucytosine cream intravaginally nightly for 14 days as a second-line option, which can be combined with 3% amphotericin B cream for enhanced efficacy 1
The Infectious Diseases Society of America recommends nystatin 100,000-unit intravaginal suppositories daily for 14 days as a second-line option, which is less effective than azoles for C. albicans but remains an option for non-albicans species 1, 2

Vaginal culture is essential to identify C. glabrata specifically, as wet mount may be negative, and vaginal pH should be ≤4.5 to confirm the diagnosis 1
Clinical symptoms of C. glabrata vaginitis include pruritus, irritation, vaginal discharge, vulvar edema, and erythema 1