What is the treatment for yeast in urine, specifically Candida species infection?

Treatment of Yeast in Urine (Candida Species Infection)

Fluconazole 200 mg (3 mg/kg) daily for 2 weeks is the first-line treatment for symptomatic candiduria caused by fluconazole-susceptible Candida species. 1, 2

Diagnostic Approach

• Candiduria with symptoms suggests cystitis rather than mere colonization, requiring treatment 1
• Asymptomatic candiduria in patients without risk factors generally requires only observation, not treatment 3, 2
• Diagnostic tests often cannot differentiate colonization from infection, so symptoms guide treatment decisions 1

Treatment Algorithm

First-Line Treatment

• For symptomatic Candida cystitis with fluconazole-susceptible species:
  • Fluconazole 200 mg (3 mg/kg) daily for 2 weeks 1, 3
  • Some evidence supports a 200-mg loading dose followed by 100 mg/day for at least 4 days 4
  • Treatment should continue until symptoms resolve and urine cultures no longer yield Candida 2, 1

Alternative Treatments for Fluconazole-Resistant Species

• For C. glabrata, C. krusei, or other fluconazole-resistant species:
  • Amphotericin B deoxycholate (AmB-d) 0.3-0.6 mg/kg daily for 1-7 days 1, 5
  • Oral flucytosine 25 mg/kg 4 times daily for 7-10 days 1, 6
  • Bladder irrigation with AmB-d at 50 mg/L of sterile water for refractory cases 2

Special Considerations

Candida Species

• C. albicans is typically susceptible to fluconazole 1, 7
• C. glabrata often requires alternative therapy due to fluconazole resistance 1, 5
• C. krusei is intrinsically resistant to fluconazole 7

Medication Considerations

• Fluconazole achieves high urinary concentrations, making it ideal for urinary tract infections 1, 8
• Echinocandins and other azoles (besides fluconazole) have minimal excretion into urine and are generally ineffective for treating Candida UTI 1, 8
• Lipid formulations of amphotericin B do not achieve adequate urine concentrations 1

High-Risk Populations Requiring Treatment Even When Asymptomatic

Treatment is recommended even for asymptomatic candiduria in:

• Neutropenic patients 3, 5
• Infants with low birth weight 3, 2
• Patients undergoing urologic procedures 3
• Severely immunocompromised patients with fever 3, 2
• Patients with urinary tract obstruction 3

Common Pitfalls to Avoid

• Treating asymptomatic candiduria in patients without risk factors for dissemination 1, 5
• Using antifungal agents with poor urinary excretion (echinocandins, voriconazole) for lower urinary tract infections 1, 8
• Overlooking the possibility of disseminated candidiasis in high-risk patients with candiduria 1, 3
• Failing to remove or replace indwelling catheters, which can resolve candiduria in almost 50% of asymptomatic patients 8
• Not considering fungus balls in patients with persistent candiduria, which may require surgical debridement in addition to antifungal therapy 2