What is the treatment for candiduria (fungal infection of the urine) in males?

From the Guidelines

For the treatment of candiduria in males, fluconazole is the recommended antifungal medication, typically given as an oral dose of 200 mg daily for 2 weeks, as it achieves high concentrations in the urine and is effective against most Candida species 1.

Treatment Approach

The approach to treating candiduria involves considering the ability of the antifungal agent to achieve adequate concentrations in the urine, as well as the antifungal susceptibilities of the infecting species.

• For cystitis due to fluconazole-susceptible Candida species, oral fluconazole is the drug of choice.
• For fluconazole-resistant organisms, alternatives include AmB-d or oral flucytosine.

Key Considerations

• The presence of yeast in the urine must be evaluated in the context of the particular clinical setting to determine its relevance and the need for antifungal therapy.
• Imaging of the urinary tract by ultrasound or CT scanning is helpful in defining structural abnormalities, hydronephrosis, abscesses, emphysematous pyelonephritis, and fungus ball formation.
• Aggregation of mycelia and yeasts (fungus balls) in bladder or kidney leads to obstruction and precludes successful treatment of infection with antifungal agents alone.

Treatment of Specific Conditions

• For pyelonephritis due to fluconazole-susceptible organisms, oral fluconazole at a dosage of 200–400 mg daily for 2 weeks is recommended.
• For fungus balls, surgical intervention is strongly recommended, along with systemic treatment with AmB-d or fluconazole.

Important Notes

• Other antifungal drugs, including the other azole agents and echinocandins, have minimal excretion of active drug into the urine and generally are ineffective in treating Candida UTI.
• Irrigation of the bladder with AmB deoxycholate resolves candiduria in 80%–90% of patients, but is generally discouraged due to the high risk of recurrent candiduria.

From the FDA Drug Label

Patients were treated with randomized study drug for a median of 15 days. Most of the candidemia in patients evaluated for efficacy was caused by C. albicans (46%), followed by C. tropicalis (19%), C. parapsilosis (17%), C. glabrata (15%), and C krusei (1%). 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 5 of 6 patients with kidney and bladder wall infections

The treatment for candiduria (fungal infection of the urine) in males is not explicitly stated in the provided drug label. However, based on the information provided, voriconazole may be effective in treating deep tissue Candida infections, including kidney and bladder wall infections.

• The overall success rate for voriconazole in treating candidemia is 41%.
• A favorable response was seen in 5 of 6 patients with kidney and bladder wall infections. However, it is essential to note that the label does not directly address the treatment of candiduria in males. 2

From the Research

Treatment for Candiduria in Males

The treatment for candiduria, a fungal infection of the urine, in males is primarily focused on symptomatic cases or those with high-risk factors.

• The antifungal agents used for treating candiduria are mainly fluconazole and amphotericin B deoxycholate, as they achieve high concentrations in urine 3, 4, 5.
• Fluconazole is the treatment of choice for symptomatic infections, due to its high urinary levels 4, 5.
• Amphotericin B deoxycholate is considered an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 3, 4.
• Other azole antifungals and echinocandins are not recommended for treating urinary tract infections, as they do not reach sufficient urine levels 4, 5.
• Removing predisposing factors, such as indwelling catheters and antibiotics, can clear candiduria in almost 50% of asymptomatic patients 5.
• In some cases, ketoconazole may be of some benefit in treating yeast urinary tract infections, but its role in relation to other antifungal drugs is not yet clear 6.
• Treatment is generally recommended only when funguria is symptomatic or in cases of fungal colonization when host factors increase the risk of fungemia 3, 7.