What is the treatment for Candida albicans in urine?

Treatment of Candida albicans in Urine

Fluconazole 200 mg orally daily for 14 days is the first-line treatment for symptomatic Candida albicans urinary tract infections, as recommended by the Infectious Diseases Society of America. 1

Diagnostic Considerations

• Obtain urine culture to confirm Candida species and susceptibility testing
• Complete metabolic panel to assess renal function
• Order blood cultures if fever is present to rule out candidemia

Treatment Algorithm

Symptomatic Candida UTI

1. First-line therapy:

   • Fluconazole 200 mg oral loading dose, then 200 mg daily for 14 days 1, 2
   • For patients on dialysis: 200 mg after each dialysis for cystitis; 200-400 mg after each dialysis for pyelonephritis 1

2. For fluconazole-resistant species:

   • Amphotericin B deoxycholate 0.3-0.6 mg/kg/day for 1-7 days 1
   • Alternative: Flucytosine 25 mg/kg 4 times daily for 7-10 days 1, 3

3. Special situations:

   • For fungal balls or abscesses: Surgical debridement plus systemic antifungal therapy 1
   • Consider local irrigation with amphotericin B (50 mg/L sterile water) as adjunct therapy 1

Asymptomatic Candiduria

• Generally does not require treatment unless patient belongs to high-risk group 1
• High-risk groups requiring treatment despite being asymptomatic:
  • Immunocompromised patients
  • Patients undergoing urologic procedures
  • Patients with suspected disseminated fungal infections

Adjunctive Measures

• Remove indwelling urinary catheters if present (resolves candiduria in ~50% of cases) 1, 4
• Ensure adequate hydration
• Monitor intake and output

Evidence Considerations

The recommendation for fluconazole is supported by both guidelines and FDA labeling. The FDA label confirms fluconazole's effectiveness for Candida urinary tract infections 2. While some studies suggest lower doses may be effective (100 mg daily following a 200 mg loading dose) 5, the Infectious Diseases Society of America guideline recommends 200 mg daily for 14 days 1.

For non-albicans Candida species, treatment efficacy varies: 93% for C. parapsilosis, 82% for C. tropicalis, but only 50% for C. glabrata 6. C. krusei should not be treated with fluconazole due to inherent resistance 6.

Monitoring and Follow-up

• Continue treatment until symptoms resolve and urine cultures become negative
• Obtain follow-up urine cultures to confirm eradication
• Monitor renal function, especially in elderly patients
• Watch for potential drug interactions (increased bleeding risk with apixaban, increased digoxin concentration) 1

Common Pitfalls to Avoid

1. Treating asymptomatic candiduria in non-high-risk patients unnecessarily 1, 3
2. Using echinocandins for uncomplicated fungal UTIs (poor urinary concentrations) 1
3. Failing to remove urinary catheters when present 1, 4
4. Not considering fluconazole resistance, especially with non-albicans Candida species 6
5. Inadequate follow-up to confirm eradication 1