What is the treatment for budding yeast on urinalysis?

Treatment for Budding Yeast on Urinalysis

For symptomatic Candida urinary tract infections, oral fluconazole at a dosage of 200 mg daily for 2 weeks is the recommended first-line treatment for fluconazole-susceptible species. 1

Treatment Algorithm Based on Clinical Presentation

Asymptomatic Candiduria

• Treatment is generally not recommended unless the patient belongs to a high-risk group 2, 1:

  • Neutropenic patients
  • Very low-birth-weight infants
  • Patients undergoing urologic procedures

• For high-risk patients undergoing urologic procedures:

  • Fluconazole 200-400 mg daily OR
  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for several days before and after the procedure 1

Symptomatic Candida Cystitis (Lower UTI)

• For fluconazole-susceptible species:

  • Fluconazole 200 mg daily for 2 weeks 2, 1

• For fluconazole-resistant species (e.g., C. glabrata, C. krusei):

  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days OR
  • Flucytosine 25 mg/kg four times daily for 7-10 days 2, 1

Candida Pyelonephritis (Upper UTI)

• For fluconazole-susceptible species:

  • Fluconazole 200-400 mg daily for 2 weeks 2, 1

• For fluconazole-resistant species:

  • Amphotericin B deoxycholate 0.5-0.7 mg/kg daily with or without flucytosine OR
  • Flucytosine alone at 25 mg/kg four times daily for 2 weeks 2, 1

Fungus Balls

• Surgical removal strongly recommended 2, 1
• Plus systemic antifungal therapy:
  • Fluconazole 200-400 mg daily OR
  • Amphotericin B deoxycholate 0.5-0.7 mg/kg daily with or without flucytosine 1
• Consider local irrigation with amphotericin B at 50 mg/L of sterile water as an adjunct to systemic therapy 2

Important Management Considerations

Non-pharmacological Interventions

• Remove indwelling urinary catheters when possible
• Discontinue unnecessary antibiotics
• Address urinary tract obstruction
• These interventions alone can resolve candiduria in approximately 50% of cases 1, 3

Antifungal Selection Considerations

• Fluconazole achieves high urinary concentrations and is the drug of choice for susceptible species 1, 3, 4
• Amphotericin B deoxycholate is effective for fluconazole-resistant species 1
• Avoid echinocandins and newer azoles (voriconazole, posaconazole) for uncomplicated fungal UTIs due to poor urinary concentrations 1, 4, 5

Common Pitfalls to Avoid

• Treating asymptomatic candiduria unnecessarily (except in high-risk groups)
• Failing to remove indwelling catheters or address underlying conditions
• Using antifungals with poor urinary concentrations (echinocandins, newer azoles)
• Not distinguishing between colonization and true infection 1
• Using flucytosine as monotherapy due to risk of resistance development 1
• Using lipid formulations of amphotericin B for lower UTIs due to inadequate urine concentrations 1

Follow-up

• Continue treatment for approximately 2 weeks
• Obtain follow-up urine cultures to confirm eradication
• Assess clinical improvement of symptoms 1