From the Guidelines
Treatment for Candida species urinary tract infection typically involves antifungal medications, with fluconazole being the first-line therapy, as recommended by the most recent guidelines 1. For uncomplicated cases, oral fluconazole 200 mg on day one followed by 100-200 mg daily for 7-14 days is usually effective. Some key points to consider in the treatment of Candida species urinary tract infection include:
- Removal of predisposing factors is crucial, including discontinuing unnecessary antibiotics, removing or changing indwelling catheters, and controlling blood glucose in diabetic patients.
- Increasing fluid intake helps flush the urinary system.
- Candida in urine often occurs in immunocompromised patients, those with diabetes, or following antibiotic use that disrupts normal flora.
- Treatment success depends on addressing underlying conditions and completing the full medication course even if symptoms improve earlier. Alternative options include:
- Oral itraconazole 200 mg twice daily for 7-14 days
- Amphotericin B bladder irrigation in resistant cases For severe or systemic infections, intravenous echinocandins like caspofungin (70 mg loading dose, then 50 mg daily) or micafungin (100 mg daily) may be necessary, as suggested by earlier guidelines 1. However, the most recent guideline 1 recommends fluconazole as the first-line therapy, and other options should be considered based on the specific clinical context and patient factors.
From the FDA Drug Label
In Studies 608 and 309/604 (non-comparative study in patients with invasive fungal infections who were refractory to, or intolerant of, other antifungal agents), voriconazole was evaluated in 35 patients with deep tissue Candida infections A favorable response was seen in 4 of 7 patients with intra-abdominal infections, 5 of 6 patients with kidney and bladder wall infections, 3 of 3 patients with deep tissue abscess or wound infection, 1 of 2 patients with pneumonia/pleural space infections, 2 of 4 patients with skin lesions, 1 of 1 patients with mixed intra-abdominal and pulmonary infection, 1 of 2 patients with suppurative phlebitis, 1 of 3 patients with hepatosplenic infection, 1 of 5 patients with osteomyelitis, 0 of 1 with liver infection, and 0 of 1 with cervical lymph node infection.
The treatment for yeast in urine, specifically Candida species infection, is voriconazole.
- Voriconazole was evaluated in patients with deep tissue Candida infections, including those with kidney and bladder wall infections.
- A favorable response was seen in 5 of 6 patients with kidney and bladder wall infections.
- The use of voriconazole for the treatment of Candida species infection in the urine is supported by the results of Studies 608 and 309/604 2.
From the Research
Treatment for Yeast in Urine
The treatment for yeast in urine, specifically Candida species infection, depends on various factors such as the presence of symptoms, the site of infection, and the patient's clinical status.
- Asymptomatic patients usually do not require antifungal therapy, except for neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures 3.
- Removing predisposing factors, such as indwelling catheters and antibiotics, can clear candiduria in almost 50% of asymptomatic patients 4, 5.
Antifungal Therapy
For symptomatic infections, antifungal therapy is necessary.
- Fluconazole is the treatment of choice, achieving high urinary levels 4, 3, 6, 5, 7.
- The recommended dose for cystitis is 400 mg on day 1 and 200 mg daily for 7 to 14 days 4.
- In cases of pyelonephritis without associated candidemia, fluconazole (3-6 mg/kg/day) for 14 days or amphotericin B at a dose of 0.5 to 0.7 mg/kg/day with or without flucytosine can be used 4.
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 3.
Other Treatment Options
Other azole antifungals and echinocandins are not recommended for the treatment of urinary tract infections since they fail to achieve adequate urine concentrations 3, 5.