Treatment of Yeast Infections in Urinary Tract Infections
For fluconazole-susceptible Candida urinary tract infections, oral fluconazole 200 mg daily for 2 weeks is the recommended treatment regimen. 1
Dosing Recommendations Based on Type of Infection
Symptomatic Candida Cystitis
- First-line treatment: Fluconazole 200 mg (3 mg/kg) daily for 2 weeks 1
- Loading dose option: Some evidence suggests a 200 mg loading dose followed by 100 mg daily for at least 4 days 2
- Remove indwelling bladder catheter if present (strongly recommended) 1
Candida Pyelonephritis
- Fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks 1
- Higher dose (400 mg) recommended for more severe infections 3
Special Situations
- Patients undergoing urologic procedures: Fluconazole 400 mg (6 mg/kg) daily for several days before and after the procedure 1
- Fungus balls/renal abscesses: Surgical intervention plus fluconazole 200-400 mg daily 1
Alternative Regimens for Fluconazole-Resistant Species
For C. glabrata infections:
- Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1
- OR oral flucytosine 25 mg/kg 4 times daily for 7-10 days 1
For C. krusei infections:
- Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1
Important Considerations
- Elimination of predisposing factors (especially catheter removal) often results in resolution of candiduria without specific antifungal therapy 1
- Treatment is not recommended for asymptomatic candiduria unless the patient belongs to a high-risk group (neutropenic patients, very low-birth-weight infants, patients undergoing urologic procedures) 1
- Susceptibility testing may be valuable for treatment failures or non-albicans Candida species 3
- Follow-up urine cultures should be obtained to confirm eradication 3
Common Pitfalls
- Undertreating: Using doses lower than 200 mg daily of fluconazole may lead to treatment failure 3
- Inadequate duration: Treatment should continue for a full 2 weeks to prevent recurrence 1
- Failing to remove catheters: Catheter removal alone can resolve candiduria in nearly half of cases 4
- Treating asymptomatic candiduria in low-risk patients: This is not recommended and represents unnecessary antibiotic use 1, 3
For most uncomplicated Candida UTIs, a single 2-week course of fluconazole 200 mg daily is sufficient to eradicate the infection while minimizing the risk of recurrence.