From the Guidelines
Treatment of candidiasis urinary tract infections typically involves antifungal medications, with fluconazole being the first-line therapy, as recommended by the most recent guidelines 1.
Overview of Treatment Guidelines
The treatment approach for candidiasis urinary tract infections (UTIs) is distinct from that of bacterial UTIs due to the eukaryotic nature of fungi, requiring different antimicrobial mechanisms.
Recommendations for Treatment
- For symptomatic cystitis due to fluconazole-susceptible Candida species, oral fluconazole at a dosage of 200 mg (3 mg/kg) daily for 2 weeks is recommended 1.
- For patients with fluconazole-resistant organisms, alternative therapies include amphotericin B deoxycholate (AmB-d) at a dosage of 0.3–0.6 mg/kg daily for 1–7 days or oral flucytosine at a dosage of 25 mg/kg 4 times daily for 7–10 days 1.
- For pyelonephritis due to fluconazole-susceptible organisms, oral fluconazole at a dosage of 200–400 mg (3–6 mg/kg) daily for 2 weeks is recommended 1.
- For patients undergoing urologic procedures, treatment with 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.
Additional Considerations
- Elimination of predisposing factors, such as indwelling bladder catheters, is crucial whenever feasible 1.
- Neutropenic patients and very low–birth-weight infants should be treated as recommended for candidemia 1.
- Patients should increase fluid intake to help flush the urinary system and complete the full course of medication even if symptoms improve.
- Follow-up urine cultures are recommended after completing treatment to confirm eradication of the infection.
From the FDA Drug Label
Candidemia in non-neutropenic patients and other deep tissue Candida infections See Table 1 Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.
The treatment guidelines for candidiasis UTI are not explicitly stated in the provided drug label. However, for candidemia in non-neutropenic patients and other deep tissue Candida infections, the recommended treatment duration is at least 14 days following resolution of symptoms or last positive culture.
- The label does not provide specific treatment guidelines for candidiasis UTI.
- The provided information is for voriconazole and its use in various fungal infections, but it does not directly address candidiasis UTI 2.
From the Research
Treatment Guidelines for Candidiasis UTI
- The treatment of choice for symptomatic candidiasis urinary tract infections (UTIs) is fluconazole, which achieves high urinary levels 3, 4, 5.
- Fluconazole is recommended for patients with symptomatic infections, while asymptomatic patients do not require antifungal therapy except in certain cases, such as neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures 3.
- The optimal dose of fluconazole for the treatment of symptomatic candidal UTI is a 200-mg loading dose followed by 100 mg/d for at least four days 4.
- Alternative antifungal agents, such as amphotericin B, may be used if fluconazole cannot be used due to resistance, allergy, or failure 3, 5.
- Newer azole agents and echinocandins are not recommended for the treatment of urinary tract infections since they fail to achieve adequate urine concentrations 5.
- Recent studies suggest that shorter antifungal treatment durations, such as 7 days, may be effective for symptomatic Candida spp. UTI, with no significant difference in clinical treatment success compared to 14-day treatment durations 6.
Risk Factors and Prevention
- Major risk factors for candidiasis UTI include diabetes mellitus, indwelling urinary catheters, use of broad-spectrum antibiotics, urinary obstruction, and admission to intensive care units 3.
- Removing predisposing factors, such as indwelling catheters and antibiotics, can clear candiduria in almost 50% of asymptomatic patients 5.
- Prophylactic administration of fluconazole can help prevent fungal infections in patients receiving cytotoxic cancer therapy 7.