What is the treatment for yeast in urine?

Treatment of Yeast in Urine

Fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks is the first-line treatment for symptomatic fungal urinary tract infections due to its high urinary concentrations and effectiveness against most Candida species. 1, 2

Diagnostic Approach

Before initiating treatment, it's crucial to determine whether the presence of yeast in urine represents:

• Asymptomatic colonization
• Symptomatic infection (cystitis, pyelonephritis)
• Disseminated candidiasis with renal involvement

Most cases of candiduria in hospitalized patients represent colonization rather than infection, especially in catheterized patients 3, 4.

Treatment Algorithm

Step 1: Assess Need for Treatment

• No treatment required for asymptomatic patients except in:
  • Neutropenic patients
  • Very low birth weight infants
  • Patients undergoing urologic procedures 2, 3

Step 2: Address Predisposing Factors

• Remove indwelling catheters if possible (strongly recommended) 1
• Discontinue unnecessary antibiotics
• Optimize management of diabetes mellitus 5
• Eliminate urinary tract obstruction if present 1

Step 3: Antifungal Therapy for Symptomatic Infections

For Fluconazole-Susceptible Candida (including C. albicans):

• Fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks 1, 6

For Fluconazole-Resistant Candida (C. glabrata, C. krusei):

• Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1
• Options include:
  • Amphotericin B deoxycholate with oral flucytosine (25 mg/kg 4 times daily)
  • Monotherapy with oral flucytosine (25 mg/kg 4 times daily for 2 weeks) 1
  • Amphotericin B bladder irrigation (50 mg/L sterile water) for refractory cystitis 1, 2

Step 4: Special Situations

For Fungus Balls:

• Surgical intervention is strongly recommended 1
• Antifungal therapy as noted above
• Consider irrigation with amphotericin B through nephrostomy tubes if present 1

Important Considerations

Agents to Avoid

• Echinocandins (caspofungin, micafungin, anidulafungin) - poor urinary concentrations 2
• Newer azoles (voriconazole, posaconazole) - inadequate urine levels 2
• Lipid formulations of amphotericin B - insufficient urinary concentrations 1
• Ketoconazole - limited efficacy in urinary tract infections 7

Monitoring Response

• Continue treatment until symptoms resolve and urine cultures no longer yield Candida species 1
• Follow-up urine cultures to document clearance
• Monitor renal function when using amphotericin B formulations

Common Pitfalls

1. Treating asymptomatic candiduria unnecessarily
2. Failing to remove indwelling catheters or address underlying conditions
3. Using antifungals with poor urinary concentrations (echinocandins, newer azoles)
4. Not distinguishing between colonization and true infection
5. Inadequate duration of therapy for symptomatic infections

Remember that the presence of Candida in urine often represents colonization rather than infection, especially in catheterized patients. Treatment should be reserved for symptomatic patients or those at high risk for dissemination 3, 4.