From the Guidelines
For symptomatic candiduria with a urinary yeast colony count of 100,000, the recommended treatment is oral fluconazole at a dosage of 200 mg daily for 2 weeks, as this is the most effective treatment for cystitis due to fluconazole-susceptible Candida species 1. The treatment approach should prioritize the elimination of predisposing factors, such as indwelling bladder catheters, whenever feasible 1. Key considerations in the treatment of symptomatic candiduria include:
- The use of antifungal agents, such as fluconazole, which is recommended for patients at high risk of dissemination, including neutropenic patients, very low-birth-weight infants, and patients undergoing urologic manipulation 1
- The dosage and duration of fluconazole treatment, which should be 200 mg daily for 2 weeks for cystitis due to fluconazole-susceptible Candida species 1
- The potential need for alternative treatments, such as amphotericin B or flucytosine, for patients with fluconazole-resistant Candida species 1
- The importance of adequate hydration to help flush the urinary system and prevent complications 1. It is essential to note that the treatment should be guided by the most recent and highest-quality evidence, which in this case is the 2016 update by the Infectious Diseases Society of America 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Yeast Infection in Urine
- The recommended treatment for a urinary yeast colony count of 100,000 in a patient with symptomatic candiduria is fluconazole, as it achieves high urinary levels 2, 3, 4.
- Fluconazole is the treatment of choice for symptomatic infections, and it is available in both oral and intravenous formulations 2, 4.
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 2.
- Other azole antifungals and echinocandins are not recommended for the treatment of urinary tract infections since they fail to achieve adequate urine concentrations 3, 4.
Considerations for Treatment
- Removing predisposing factors, such as indwelling catheters and antibiotics, will clear candiduria in almost 50% of asymptomatic patients 3.
- For patients with symptomatic Candida urinary tract infections, the choice of antifungal agent will depend upon the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the agent 4.
- Irrigation of the bladder with antifungal agents has limited utility, but it can be useful in combination with systemic antifungal agents for fungus balls 4.
Antifungal Agents
- The four main classes of antifungal drugs are the polyenes, azoles, allylamines, and echinocandins 5.
- Clinically useful "older" agents include topical azole formulations, first-generation triazoles (fluconazole and itraconazole), amphotericin B formulations, and terbinafine 5.
- Clinically important "newer" agents include members of the echinocandin class (eg, caspofungin) and second-generation triazoles (eg, voriconazole and posaconazole) 5.