What is the treatment for urine candida infection?

Treatment of Urine Candida Infection

Fluconazole is the drug of choice for treating Candida urinary tract infections, with a recommended dosage of 200 mg (3 mg/kg) daily for 2 weeks for fluconazole-susceptible organisms. 1

Treatment Algorithm Based on Candida Species and Clinical Presentation

For Cystitis:

• For fluconazole-susceptible organisms (most commonly C. albicans):

  • Oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks 1
  • Remove indwelling bladder catheter if present (strongly recommended) 1

• For fluconazole-resistant C. glabrata:

  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days OR oral flucytosine 25 mg/kg 4 times daily for 7-10 days 1
  • Amphotericin B deoxycholate bladder irrigation (50 mg/L sterile water daily for 5 days) may be useful 1

• For C. krusei:

  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1

For Pyelonephritis:

• For fluconazole-susceptible organisms:

  • Oral fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks 1
  • Eliminate urinary tract obstruction if present 1

• For fluconazole-resistant C. glabrata:

  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days, with or without oral flucytosine 25 mg/kg 4 times daily 1
  • Alternative: monotherapy with oral flucytosine 25 mg/kg 4 times daily for 2 weeks 1

• For C. krusei:

  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1

For Fungus Balls:

• Surgical intervention is strongly recommended in adults 1
• Antifungal treatment as noted above for cystitis or pyelonephritis 1
• Irrigation through nephrostomy tubes, if present, with Amphotericin B deoxycholate 25-50 mg in 200-500 mL sterile water 1

Pharmacological Considerations

Fluconazole is preferred for several key reasons:

• It achieves high concentrations in the urine in its active form 1, 2
• It is available as an oral formulation 1
• It was proven effective in the only randomized, double-blind, placebo-controlled trial for candiduria 1, 3

Other antifungal agents have limitations:

• Flucytosine has good activity against many Candida species (except C. krusei) and is excreted in urine, but has toxicity concerns and risk of resistance development when used alone 1
• Amphotericin B deoxycholate is effective but requires intravenous administration and has toxicity concerns 1
• Lipid formulations of amphotericin B do not achieve adequate urine concentrations 1
• Other azoles and echinocandins have minimal excretion into urine and are generally ineffective for Candida UTI 1, 4

Important Clinical Considerations

• Differentiate between colonization and true infection before initiating treatment 5, 6

• Asymptomatic candiduria often resolves with removal of predisposing factors (catheters, antibiotics) without antifungal therapy 5, 4

• Treatment is indicated for:

  • Symptomatic patients 5
  • Neutropenic patients 5
  • Very low-birth-weight infants 5
  • Patients undergoing urologic procedures 1, 5

• For patients undergoing urologic procedures:

  • Oral fluconazole 400 mg (6 mg/kg) daily OR amphotericin B deoxycholate 0.3-0.6 mg/kg daily for several days before and after the procedure 1

• For patients with nephrostomy tubes or stents:

  • Consider removal or replacement if feasible 1

Common Pitfalls and Caveats

• Colony count in urine cannot reliably differentiate between colonization and infection, especially when a catheter is present 1
• Pyuria in catheterized patients does not reliably differentiate Candida infection from colonization 1
• Long-term eradication rates with fluconazole may be disappointing despite initial success 3
• Echinocandins may be effective for renal parenchymal infections despite poor urinary concentrations, but clinical data is limited 1
• Bladder irrigation with amphotericin B resolves candiduria in 80-90% of patients but has high recurrence rates and is generally discouraged except for specific cases 1