Fluconazole Dosing for Yeast in Urine
For treating symptomatic yeast in urine (candiduria), fluconazole 200 mg daily for 2 weeks is the recommended dosage for fluconazole-susceptible Candida species. 1
Treatment Indications
Treatment of asymptomatic candiduria is NOT recommended unless the patient belongs to one of these high-risk groups:
- Neutropenic patients
- Very low-birth-weight infants (<1500g)
- Patients undergoing urologic manipulation 1, 2
For high-risk patients undergoing urologic procedures:
- Fluconazole 400 mg (6 mg/kg) daily for several days before and after the procedure 1
Dosing Recommendations by Scenario
1. Symptomatic Candida Cystitis
- Fluconazole-susceptible species: 200 mg (3 mg/kg) daily for 2 weeks 1
- Fluconazole-resistant C. glabrata:
- C. krusei: Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1
2. Candida Pyelonephritis
- Fluconazole-susceptible species: 200-400 mg (3-6 mg/kg) daily for 2 weeks 1
- Fluconazole-resistant C. glabrata:
Important Clinical Considerations
Catheter Management
- Removal of indwelling bladder catheters is strongly recommended whenever feasible 1, 2
- Elimination of urinary tract obstruction is strongly recommended if present 1
Renal Impairment Dosing Adjustments
- Creatinine clearance >50 mL/min: 100% of recommended dose
- Creatinine clearance ≤50 mL/min (no dialysis): 50% of recommended dose
- Hemodialysis: 100% of recommended dose after each hemodialysis session 3
Treatment Duration
- Minimum 2 weeks for cystitis 1
- Continue until symptoms have resolved and urine cultures no longer yield Candida species 1
Alternative Approaches for Resistant Organisms
- Amphotericin B deoxycholate bladder irrigation (50 mg/L sterile water daily for 5 days) may be useful for fluconazole-resistant species 1, 2
Evidence Quality and Caveats
The recommended dosing is based on guidelines from the Infectious Diseases Society of America, which provides strong recommendations despite some evidence being of low to moderate quality. Some studies suggest a loading dose approach (200 mg followed by 100 mg daily) 4, but the most recent guidelines recommend a consistent 200 mg daily dose for cystitis and 200-400 mg daily for pyelonephritis 1.
Fluconazole achieves high concentrations in urine, making it particularly effective for urinary tract infections with susceptible organisms 5. However, resistance patterns, particularly with C. glabrata, must be considered when selecting therapy.
Remember that treatment of asymptomatic candiduria is generally not recommended unless the patient is in a high-risk group, as elimination of predisposing factors often results in resolution of candiduria without specific antifungal therapy 1.