From the Guidelines
The treatment for Candida urinary tract infection (UTI) should be fluconazole as the first-line therapy, with a recommended dosage of 200 mg daily for 2 weeks for cystitis due to fluconazole-susceptible Candida species. This recommendation is based on the most recent and highest quality study available, which is the 2016 update by the Infectious Diseases Society of America 1. For uncomplicated cases, oral fluconazole is the preferred treatment due to its efficacy, safety, and ability to achieve high concentrations in the urine.
Some key points to consider in the treatment of Candida UTI include:
- The ability of the antifungal agent to achieve adequate concentrations in the urine is crucial for effective treatment 1.
- Fluconazole is the drug of choice for treating Candida UTI, especially for Candida albicans, which is the most common cause of fungal UTI 1.
- Alternative medications such as oral flucytosine or amphotericin B deoxycholate may be considered for fluconazole-resistant strains or more severe infections 1.
- Removal or replacement of urinary catheters is essential if present, as they can serve as a reservoir for fungal colonization.
- Adequate hydration helps flush out the urinary system and is an important adjunct to antifungal therapy.
It's also important to note that the treatment approach may vary depending on the severity of the infection, the presence of underlying risk factors, and the susceptibility of the infecting Candida species to antifungal agents. In general, fluconazole remains the preferred treatment option due to its efficacy, safety, and ease of use, as supported by the 2016 clinical practice guideline for the management of candidiasis 1.
From the Research
Treatment Options for Candida UTI
The treatment for Candida urinary tract infection (UTI) depends on various factors, including the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the antifungal agent 2.
- Antifungal Therapy: Not all cases of candiduria require antifungal therapy. In many instances, candiduria represents colonization or contamination of the specimen, and further investigation may reveal predisposing factors that can be corrected or treated, resulting in the resolution of the infection 2.
- Choice of Antifungal Agent: For symptomatic UTIs, fluconazole is preferred due to its safety, high concentrations in urine, and availability in both oral and intravenous formulations 2, 3.
- Alternative Therapies: Flucytosine and low-dose amphotericin B may be useful in selected patients, but their use requires caution due to toxicity 2. Echinocandins, such as caspofungin, may also be effective in treating Candida-related UTIs, especially in cases of fluconazole-resistant Candida species 4.
- Treatment Duration and Dose: A fluconazole 200-mg loading dose followed by 100 mg/d for at least four days appears to be an appropriate dose for the treatment of symptomatic candidal UTI in patients without systemic fungal infection or severe renal failure 3.
- Newer Azole Agents and Echinocandins: These agents are not recommended for the treatment of urinary tract infections since they fail to achieve adequate urine concentrations 5.
- Irrigation of the Bladder: Irrigation of the bladder with antifungal agents has limited utility, but irrigation of the renal pelvis through a nephrostomy tube can be useful in combination with systemic antifungal agents in cases of fungus balls 2.