From the Guidelines
The management of positive yeast budding in urine typically involves antifungal therapy, with fluconazole being the first-line treatment, as recommended by the most recent guidelines 1. For uncomplicated cases, prescribe fluconazole 200 mg orally on day 1, followed by 100 mg daily for 7-14 days.
- The treatment duration may be extended to 14-21 days for severe or complicated infections.
- Alternative options include itraconazole 200 mg twice daily for 7-14 days or amphotericin B for resistant cases, as suggested by the guidelines 1. Some key points to consider in the management of positive yeast budding in urine include:
- Removal of predisposing factors is crucial, such as discontinuing unnecessary antibiotics, removing or replacing indwelling catheters, and optimizing glycemic control in diabetic patients.
- Increased fluid intake helps flush the urinary tract.
- For recurrent infections, consider prophylactic fluconazole 150 mg weekly.
- Yeast in urine (usually Candida species) often represents colonization rather than true infection, so treatment should be reserved for symptomatic patients, immunocompromised individuals, or those with risk factors for disseminated infection, as recommended by the guidelines 1. The presence of pyuria, symptoms, or high colony counts (>10,000 CFU/mL) helps distinguish true infection from colonization, and the guidelines recommend treatment with antifungal agents only for patients at high risk for dissemination 1.
- The guidelines also recommend elimination of predisposing factors, such as indwelling bladder catheters, whenever feasible 1. It is essential to note that the management of positive yeast budding in urine should be based on the most recent and highest-quality evidence, and the guidelines provide a strong recommendation for the use of fluconazole as the first-line treatment 1.
From the Research
Management of Positive Yeast Budding in Urine
The management of positive yeast budding in urine, also known as candiduria, depends on various factors, including the presence of symptoms and the patient's underlying medical conditions.
- Asymptomatic patients: In most cases, asymptomatic candiduria does not require antifungal therapy, except in certain high-risk patients, such as neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures 2, 3, 4.
- Symptomatic patients: For patients with symptomatic Candida urinary tract infections, antifungal therapy is warranted.
Treatment Options
- Fluconazole is the treatment of choice for symptomatic infections, as it achieves high urinary levels 2, 3, 4, 5.
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 2, 4.
- Other azole antifungals and echinocandins are not recommended for the treatment of urinary tract infections, as they do not reach sufficient urine levels 2, 3, 4.