From the Guidelines
Treatment for a Candida urinary tract infection (UTI) is indicated when a patient has symptoms of UTI along with significant fungal growth in urine culture, or in asymptomatic patients with specific risk factors, such as neutropenic patients, very low-birth-weight infants, and patients who will undergo urologic manipulation, as recommended by the 2016 update by the Infectious Diseases Society of America 1.
Indications for Treatment
- Symptomatic patients with symptoms like dysuria, frequency, urgency, or suprapubic pain accompanied by candiduria
- Asymptomatic patients with specific risk factors, including:
- Neutropenic patients
- Very low-birth-weight infants
- Patients undergoing urologic procedures
- Renal transplant recipients
- Patients with renal allografts
First-Line Treatment
- Oral fluconazole 200-400 mg daily for 7-14 days, due to its excellent urinary penetration, as shown in a randomized, double-blind, placebo-controlled trial 1
Alternative Treatments
- For fluconazole-resistant species, alternatives include:
- Amphotericin B deoxycholate (0.3-0.6 mg/kg daily)
- Flucytosine (25 mg/kg four times daily)
- Echinocandins like caspofungin are generally avoided as they don't achieve adequate urinary concentrations, but may be used in salvage therapy or in situations where resistance or toxicity preclude the use of AmB deoxycholate or fluconazole 1
Additional Considerations
- Removal or replacement of urinary catheters is essential when present, as catheters serve as a nidus for biofilm formation
- Treatment is necessary because untreated fungal UTIs can lead to ascending infection, fungal balls causing obstruction, or systemic candidiasis in immunocompromised patients
- Imaging of the urinary tract by ultrasound or CT scanning may be helpful in defining structural abnormalities, hydronephrosis, abscesses, emphysematous pyelonephritis, and fungus ball formation 1
From the FDA Drug Label
- 2 Candidemia in Non-neutropenic Patients and Other Deep Tissue Candida Infections Voriconazole tablets are indicated in adults and pediatric patients (aged 12 to 14 years weighing greater than or equal to 50 kg and those aged 15 years and older regardless of body weight) for the treatment of candidemia in non-neutropenic patients and the following Candida infections: disseminated infections in skin and infections in abdomen, kidney, bladder wall, and wounds
Treatment Indication: Treatment with voriconazole is indicated for Candida infections, including candidemia in non-neutropenic patients and other deep tissue Candida infections, such as disseminated infections in skin and infections in abdomen, kidney, bladder wall, and wounds 2.
- Key Points:
- Treatment is indicated for candidemia in non-neutropenic patients
- Treatment is indicated for other deep tissue Candida infections, including disseminated infections in skin and infections in abdomen, kidney, bladder wall, and wounds
- Voriconazole tablets are approved for use in adults and pediatric patients (aged 12 to 14 years weighing greater than or equal to 50 kg and those aged 15 years and older regardless of body weight) 2 2
From the Research
Indications for Treatment
Treatment for a Candida urinary tract infection (UTI) is indicated in the following situations:
- Symptomatic patients 3, 4, 5, 6
- Neutropenic patients 3
- Very low-birth-weight infants 3
- Patients undergoing urologic procedures 3
- Patients with funguria and underlying health conditions that increase the risk of fungemia 6
Treatment Options
The choice of antifungal agent depends on the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the agent.
- Fluconazole is the preferred treatment for Candida UTIs due to its safety, high concentrations in urine, and availability in both oral and intravenous formulations 3, 4, 5, 7
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 3, 5, 6
- Amphotericin B bladder irrigations (ABBI) may be considered an alternative to fluconazole for the treatment of candiduria, especially in patients with renal dysfunction 4