From the Guidelines
Treatment for candiduria with a yeast colony count of 50,000 in urine is not recommended unless the patient belongs to a group at high risk for dissemination, such as neutropenic patients, very low-birth-weight infants, or patients who will undergo urologic manipulation 1. For patients without risk factors, elimination of predisposing factors, such as indwelling bladder catheters, is recommended whenever feasible 1. However, for high-risk patients, treatment with antifungal agents, such as oral fluconazole, 400 mg (6 mg/kg) daily, or AmB deoxycholate, 0.3–0.6 mg/kg daily, for several days before and after the procedure, is recommended 1. Some key points to consider in the treatment of candiduria include:
- Addressing underlying factors, such as removing unnecessary catheters, controlling blood glucose in diabetics, and reducing immunosuppressive medications when possible
- Monitoring treatment effectiveness with follow-up urine cultures
- Considering the clinical context, as candiduria often represents colonization rather than infection, but can indicate systemic candidiasis in immunocompromised patients Alternative medications, such as oral flucytosine (25 mg/kg four times daily) or amphotericin B bladder irrigation (50 mg/L sterile water daily for 5-7 days), may be considered for fluconazole-resistant species 1. It is essential to prioritize the patient's risk factors and clinical context when determining the necessity of treatment, as the majority of candiduria cases are asymptomatic and may resolve with the removal of predisposing factors 1.
From the Research
Treatment for Candiduria
- The treatment for candiduria with a yeast colony count of 50,000 in urine depends on the presence of symptoms and the patient's underlying health conditions 2, 3.
- Asymptomatic patients with candiduria do not typically require antifungal therapy, except in cases where the patient is neutropenic, a very low-birth-weight infant, or undergoing urologic procedures 2.
- For symptomatic patients, fluconazole is the treatment of choice, as it achieves high urinary levels and is effective against most Candida species 2, 3, 4.
- Alternative antifungal agents, such as amphotericin B, may be used in cases where fluconazole is not effective or cannot be used due to resistance or allergy 2, 3, 4.
- Other azole antifungals and echinocandins are not recommended for the treatment of urinary tract infections, as they do not achieve sufficient urine levels 2, 3, 4.
Risk Factors and Management
- Candiduria is often associated with underlying risk factors, such as diabetes mellitus, indwelling urinary catheters, use of broad-spectrum antibiotics, and urinary obstruction 2, 4.
- Removing predisposing factors, such as indwelling catheters and antibiotics, can help clear candiduria in almost 50% of asymptomatic patients 3.
- Strategies for management are based on the evaluation of candiduria in the context of the clinical setting to determine its relevance and make an appropriate decision about the need for antifungal therapy 4.