From the Guidelines
Treatment for candiduria is generally indicated only in symptomatic patients or those at high risk for disseminated infection, such as neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures. Asymptomatic candiduria in most patients does not require treatment, as it often resolves spontaneously after removal of predisposing factors, such as indwelling bladder catheters 1.
Specific Indications for Treatment
- Symptomatic patients with urinary tract symptoms
- Neutropenic patients
- Patients undergoing urologic procedures
- Very low-birth-weight infants
Recommended Approach
- First, remove or change indwelling urinary catheters if present, as this can often lead to resolution of candiduria 1.
- Administer oral fluconazole 400 mg (6 mg/kg) daily, as recommended for patients undergoing urologic procedures 1.
- For fluconazole-resistant species, consider IV amphotericin B 0.3-0.6 mg/kg daily for several days before and after the procedure, as an alternative to fluconazole 1. The rationale for limited treatment is that candiduria often resolves spontaneously, especially after catheter removal, and overtreatment can lead to antifungal resistance 1. Treatment aims to prevent ascending infection or dissemination in high-risk patients. Fluconazole is preferred due to its excellent urinary penetration and low toxicity profile.
From the Research
Indications for Treatment of Candiduria
The indications for treatment of candiduria are as follows:
- Symptomatic candiduria, where patients exhibit symptoms such as dysuria, frequency, or flank pain 2, 3, 4, 5, 6
- High-risk patients, such as those with neutropenia, recent urinary tract instrumentation, or indwelling catheters 2, 3, 4, 5, 6
- Patients with underlying medical conditions, such as diabetes, or those who are immunocompromised 2, 3, 4, 5, 6
- Patients with positive blood cultures for Candida species 2
Treatment Options
The treatment options for candiduria include:
- Fluconazole, which is the antifungal agent of choice for treating symptomatic Candida urinary tract infections 5, 6
- Amphotericin B, which can be used for severe or resistant cases 2, 6
- Removal of indwelling catheters and discontinuation of antibiotics to clear candiduria in asymptomatic patients 3, 4, 6
- Bladder irrigation with amphotericin B or fluconazole for patients with symptomatic candiduria 2
Special Considerations
Special considerations for treating candiduria include:
- Asymptomatic candiduria does not typically require antifungal therapy, and removal of predisposing factors such as indwelling catheters and antibiotics may be sufficient to clear the infection 3, 4, 6
- Patients with candiduria and high risk for developing hematogenous infection may require blood cultures and close monitoring 2
- The choice of antifungal agent and treatment duration should be individualized based on the patient's clinical presentation, underlying medical conditions, and susceptibility of the Candida species 2, 5, 6