From the Guidelines
For an 85-year-old afebrile man with a chronic suprapubic tube who has persistent funguria (>100,000 CFU of Candida) despite tube change, the next step is to observe without antifungal treatment. Asymptomatic candiduria in patients with chronic indwelling catheters typically does not require treatment, as it represents colonization rather than infection 1. Treatment is generally not recommended unless the patient develops symptoms of a urinary tract infection, has neutropenia, is undergoing urologic procedures, or has risk factors for disseminated candidiasis. The presence of Candida in the urine of catheterized patients is common and often resolves spontaneously or persists without causing harm. Unnecessary antifungal therapy can lead to drug resistance, side effects, and increased healthcare costs without clinical benefit. Some key points to consider in the management of candiduria include:
- The ability of the antifungal agent to achieve adequate concentrations in the urine is as important as the antifungal susceptibilities of the infecting species 1
- Fluconazole is the drug of choice for treating Candida UTI, as it achieves high concentrations in the urine and is effective in eradicating candiduria 1
- Other antifungal drugs, including the other azole agents and echinocandins, have minimal excretion of active drug into the urine and generally are ineffective in treating Candida UTI 1 If the patient develops fever, flank pain, or other symptoms suggesting infection, then fluconazole 400 mg initially followed by 200 mg daily for 7-14 days would be appropriate treatment.
From the FDA Drug Label
Urinary tract infections and peritonitis: For the treatment of Candida urinary tract infections and peritonitis, daily doses of 50 to 200 mg have been used in open, noncomparative studies of small numbers of patients.
The next step is to consider treating the patient with fluconazole at a daily dose of 50 to 200 mg for the treatment of Candida urinary tract infection.
- The patient's age and condition should be taken into consideration when determining the dosage.
- Treatment should be continued until clinical parameters or laboratory tests indicate that active fungal infection has subsided 2.
From the Research
Funguria Treatment Options
The patient has a chronic suprapubic (SP) tube and >100,000 CFU of Candida on culture, with persistent funguria after SP tube change. The next step in treatment could involve antifungal therapy.
- Treatment options for candiduria include:
- Fluconazole: effective against Candida species, including those with decreased susceptibility to fluconazole 3, 4
- Voriconazole: effective against Candida species, with a broader spectrum of activity than fluconazole 3, 4, 5
- Echinocandins (e.g., anidulafungin): effective against Candida species, with a narrower spectrum of activity than azoles but fungicidal activity 6, 5, 7
- Amphotericin B: effective against Candida species, but with potential toxicity, particularly renal toxicity 3, 6, 7
Considerations for Treatment
When selecting an antifungal agent, considerations should include: