From the Guidelines
Retreatment for persistent yeast in urine culture is not always necessary and should be based on the patient's symptoms and risk factors. According to the clinical practice guidelines for the management of candidiasis by the Infectious Diseases Society of America 1, asymptomatic candiduria generally does not require treatment, especially in patients without risk factors.
Key Considerations
- The decision to retreat should be based on the presence of symptoms such as dysuria, frequent urination, or flank pain, rather than the culture results alone.
- Patients with risk factors such as immunocompromised status, neutropenia, urinary tract abnormalities, or upcoming urologic procedures may require retreatment, even if asymptomatic.
- For symptomatic patients or those with risk factors, oral fluconazole at a dosage of 200 mg (3 mg/kg) daily for 2 weeks is recommended for cystitis due to fluconazole-susceptible Candida species 1.
- Alternative options for fluconazole-resistant organisms include 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.
Addressing Underlying Factors
- Removing or changing indwelling catheters if present is crucial in managing candiduria.
- Controlling diabetes if applicable and discontinuing unnecessary antibiotics can also help in preventing recolonization.
- It is essential to note that persistent candiduria often represents colonization rather than infection, particularly in catheterized patients, and treating asymptomatic cases rarely provides long-term clearance as recolonization commonly occurs when predisposing factors remain.
From the FDA Drug Label
The efficacy of fluconazole for the suppression of cryptococcal meningitis was successful in 4 of 5 children treated in a compassionate-use study of fluconazole for the treatment of life-threatening or serious mycosis.
The FDA drug label does not answer the question.
From the Research
Treatment of Yeast in Urine
If a urine culture (UC) remains positive for yeast after initial treatment, the decision to retreat the patient depends on several factors.
- The patient's symptoms and underlying health status play a crucial role in determining the need for further treatment 2, 3.
- Asymptomatic patients may not require antifungal therapy, except in cases where they are neutropenic, very low-birth-weight infants, or undergoing urologic procedures 2.
- Fluconazole is the treatment of choice for symptomatic infections, as it achieves high urinary levels 2, 3, 4.
- In cases where fluconazole cannot be used due to resistance, allergy, or failure, amphotericin B deoxycholate is an alternative antifungal agent 2.
Retreatment Considerations
- Removing predisposing factors, such as indwelling catheters and antibiotics, can clear candiduria in almost 50% of asymptomatic patients 4.
- For patients with symptomatic Candida urinary tract infections, a variety of treatment options are available, including fluconazole irrigation for catheter-associated candiduria 5.
- The diagnosis of Candida urinary tract infections requires careful evaluation, including verification of funguria, urinalysis, and urine culture, as well as imaging studies such as ultrasonography or computed tomography (CT) in symptomatic or critically ill patients 6.
Key Points
- The presence of Candida species in urine does not always warrant antifungal therapy.
- Symptomatic patients and those with underlying health conditions may require treatment.
- Fluconazole is the preferred treatment option due to its high urinary levels.
- Retreatment should be considered on a case-by-case basis, taking into account the patient's symptoms, underlying health status, and response to initial treatment 2, 3, 4.