From the Guidelines
Treatment for Candida in the urine is not always necessary and should only be considered if symptoms of a urinary tract infection are present, or if the individual is immunocompromised, about to undergo urinary tract procedures, or critically ill. The decision to treat candiduria depends on various factors, including the presence of symptoms, the patient's underlying health status, and the potential risks associated with treatment.
- For symptomatic cases, fluconazole 200mg orally on day one followed by 100mg daily for 7-14 days is typically recommended 1.
- Alternatively, amphotericin B bladder irrigation may be used in certain cases, especially for patients with fluconazole-resistant Candida species 1.
- If an indwelling catheter is present, removing or changing it often resolves the issue 1.
- Asymptomatic candiduria in healthy individuals usually doesn't require treatment as it often represents colonization rather than infection and may resolve spontaneously 1.
- The presence of Candida in urine can be due to contamination during sample collection, colonization, or true infection, which is why context and symptoms matter 1.
- It's essential to consult a healthcare provider for proper evaluation of the specific situation, as the approach to treatment may vary depending on the individual's circumstances and the severity of the infection 1.
From the FDA Drug Label
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. In open noncomparative studies of relatively small numbers of patients, fluconazole tablets were also effective for the treatment of Candida urinary tract infections, peritonitis, and systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia.
Treatment is necessary for Candida in the urine, as it is a fungal infection that can cause urinary tract infections. The dosage of fluconazole for treating Candida urinary tract infections is 50 to 200 mg daily, as stated in the drug label 2 and 2.
From the Research
Treatment of Candida in Urine
- The need to treat Candida in the urine depends on whether the infection is symptomatic or asymptomatic 3, 4.
- Asymptomatic candiduria does not typically require antifungal therapy, except in certain cases such as neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures 3, 4.
- Symptomatic Candida urinary tract infections can be treated with antifungal agents, with fluconazole being the preferred choice due to its safety, high urinary concentrations, and availability in both oral and intravenous formulations 5, 3, 4.
Antifungal Treatment Options
- Fluconazole is the treatment of choice for symptomatic infections and achieves high urinary levels 3, 4.
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 3.
- Echinocandins, such as micafungin, may be effective in certain cases, but their use is not well established due to poor urinary concentrations 5.
- Flucytosine is concentrated in urine and has broad activity against Candida species, but its use requires caution due to toxicity 4, 6.
Considerations for Treatment
- The presence of Candida species in urine in asymptomatic patients does not warrant antifungal therapy, except in specific cases 3, 4.
- Overtreatment of asymptomatic candiduria is common and can lead to unnecessary antifungal use and potential toxicities 7.
- The choice of antifungal agent will depend on the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the agent 4.