What is the treatment for a UTI caused by Candida?

Treatment of Candida Urinary Tract Infections

For UTIs caused by Candida species, fluconazole is the first-line treatment due to its excellent urinary concentration, with a recommended regimen of 200 mg loading dose followed by 100 mg daily for at least 4 days. 1, 2, 3

First-Line Treatment Options

• Fluconazole:

  • Achieves high urinary concentrations
  • Recommended dosing: 200 mg loading dose, then 100 mg daily for at least 4 days 3
  • Duration: Continue for approximately 2 weeks, or until symptoms resolve and urine cultures become negative 4
  • Effective for most Candida species except C. krusei (intrinsically resistant) and some C. glabrata strains

• Amphotericin B deoxycholate:

  • Alternative when fluconazole cannot be used (resistance, allergy, or treatment failure) 2
  • Dosage: 0.3-0.6 mg/kg daily for 1-7 days 4
  • Achieves high urinary concentrations
  • Resolves candiduria in 80-90% of patients, though recurrence is common 4
  • First-line for C. krusei UTIs due to intrinsic fluconazole resistance 4

Management Algorithm

1. Confirm true infection vs. colonization:

   • Asymptomatic candiduria generally does not require treatment except in:
     • Neutropenic patients
     • Very low-birth-weight infants
     • Patients undergoing urologic procedures 2

2. Address predisposing factors:

   • Remove indwelling catheters if present (resolves ~50% of cases) 4, 5
   • Discontinue unnecessary antibiotics
   • Manage diabetes mellitus if present 6
   • Eliminate urinary tract obstruction if present 4

3. Select antifungal therapy based on species:

   • For most Candida species: Fluconazole
   • For C. krusei or fluconazole-resistant strains: Amphotericin B deoxycholate

4. Special situations:

   • For fungal balls or obstructing mycelial masses: Surgical or endoscopic removal plus antifungal therapy 4
   • For nephrostomy tubes: Consider irrigation with amphotericin B deoxycholate (25-50 mg in 200-500 mL sterile water) 4

Important Considerations

• Non-albicans Candida species are increasingly common in nosocomial UTIs (71.4% in one study) 6
• Concomitant candidemia occurs in approximately 4.3% of patients with candiduria 6
• Follow-up urine cultures are essential to confirm eradication 4

Treatments to Avoid

• Echinocandins (caspofungin, micafungin, anidulafungin): Poor urinary concentrations; not recommended for uncomplicated fungal UTIs 4, 5

  • Exception: May be considered when infection has invaded renal tissue 4

• Newer azoles (voriconazole, posaconazole): Poor urinary concentrations 4, 5

• Lipid formulations of amphotericin B: Inadequate urine concentrations; not recommended for lower UTIs 4

• Flucytosine: Should not be used as monotherapy due to risk of resistance development 4

Common Pitfalls to Avoid

• Treating asymptomatic candiduria unnecessarily
• Failing to remove indwelling catheters or address underlying conditions
• Using antifungals with poor urinary concentrations
• Not distinguishing between colonization and true infection 4
• Inadequate duration of therapy (should continue until symptoms resolve and cultures are negative) 4