From the Guidelines
Fluconazole is the recommended treatment for candiduria, with a dosage of 200mg daily for 2 weeks for cystitis due to fluconazole-susceptible Candida species. The treatment of candiduria depends on the severity of the infection and the susceptibility of the Candida species to antifungal agents. For patients with symptomatic candiduria, treatment is recommended to prevent complications such as disseminated candidiasis 1.
Treatment Options
- For cystitis due to fluconazole-susceptible Candida species, oral fluconazole at a dosage of 200mg daily for 2 weeks is recommended 1.
- For fluconazole-resistant organisms, alternative treatments 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.
- For pyelonephritis due to fluconazole-susceptible organisms, oral fluconazole at a dosage of 200–400 mg daily for 2 weeks is recommended 1.
Important Considerations
- Elimination of predisposing factors, such as indwelling bladder catheters, is recommended whenever feasible 1.
- Treatment with antifungal agents is not recommended unless the patient belongs to a group at high risk for dissemination, such as neutropenic patients, very low-birth-weight infants, or patients who will undergo urologic manipulation 1.
- Patients undergoing urologic procedures should be treated with oral fluconazole or AmB deoxycholate for several days before and after the procedure 1.
Prevention of Recurrence
- Drinking plenty of water to help flush the urinary system and completing the full course of medication even if symptoms improve can help prevent recurrence.
- Avoiding irritants like scented products in the genital area, wearing breathable cotton underwear, and maintaining good hygiene can also help prevent recurrence.
From the FDA Drug Label
Fluconazole tablets are indicated for the treatment of: ... In open noncomparative studies of relatively small numbers of patients, fluconazole tablets were also effective for the treatment of Candida urinary tract infections, ...
The treatment for candiduria (fungal infection of the urine) is fluconazole [@\1@].
From the Research
Treatment Options for Candiduria
- The treatment of choice for symptomatic candiduria is fluconazole, which achieves high urinary levels 2, 3, 4, 5.
- Fluconazole is recommended for patients with symptomatic Candida urinary tract infections, including cystitis, pyelonephritis, prostatitis, epididymo-orchitis, or disseminated candidiasis 2, 3.
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 2, 3.
- Other azole antifungals and echinocandins are not recommended for the treatment of urinary tract infections because they do not reach sufficient urine levels 2, 3.
- Removing predisposing factors, such as indwelling catheters and antibiotics, can clear candiduria in almost 50% of asymptomatic patients 3.
- Catheter replacement alone can lead to an 87-93% clearance of urinary findings at 8 weeks of follow-up 4.
- Nitroxoline, an antibiotic with antifungal activity, can be used to terminate candiduria, especially in cases where foreign bodies in the urinary tract need to be removed 6.
Dosage Recommendations
- A fluconazole 200-mg loading dose followed by 100 mg/d for at least four days appears to be the most appropriate dose for the treatment of symptomatic candidal UTI in patients without systemic fungal infection or severe renal failure 5.
- Low-dose fluconazole (100 mg followed by 50 mg/day for 14 days) can induce a rapid and almost complete eradication of funguria and urinary WBCs 4.
Special Considerations
- Antifungal therapy is not warranted in asymptomatic patients, except in cases of neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures 2.
- Therapy is indicated in all cases where a urological manipulation is planned, particularly those with injury to the mucosal barrier, to prevent an intraoperative spread of pathogens 6.