Fluconazole Dosing for Fungal UTI
For fluconazole-susceptible Candida urinary tract infections, the recommended dose is 200 mg (3 mg/kg) daily for 2 weeks. 1
Treatment Algorithm Based on Clinical Presentation
Asymptomatic Candiduria
- Treatment with antifungal agents is NOT recommended unless the patient belongs to a high-risk group for dissemination 1, 2
- High-risk groups requiring treatment include:
Symptomatic Fungal UTI (Candida Cystitis)
- For fluconazole-susceptible organisms: 200 mg (3 mg/kg) daily for 2 weeks 1
- Remove indwelling bladder catheters if present (this alone may resolve candiduria in nearly 50% of cases) 1, 2
- For patients undergoing urologic procedures: 400 mg (6 mg/kg) daily for several days before and after the procedure 1
Fungal Pyelonephritis
- For fluconazole-susceptible organisms: 200-400 mg (3-6 mg/kg) daily for 2 weeks 1
- Eliminate urinary tract obstruction if present 1
- Consider removal or replacement of nephrostomy tubes or stents if present 1
Special Considerations for Fluconazole-Resistant Species
C. glabrata Infections
- Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days OR 1
- Oral flucytosine 25 mg/kg 4 times daily for 7-10 days 1
- For pyelonephritis: Consider combination therapy with both agents above 1
C. krusei Infections
- Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1
Dosing in Special Populations
Hemodialysis Patients
- 200 mg after each hemodialysis session 2
Patients with Renal Impairment
- For peritonitis in CAPD patients: 50 mg intraperitoneally or 100 mg orally 3
Clinical Pearls and Caveats
- A loading dose is generally recommended on the first day of therapy to achieve steady-state plasma concentrations more quickly 4
- For fungal balls or obstructive uropathy, surgical intervention is strongly recommended in addition to antifungal therapy 1, 2
- Continuing indwelling catheters during treatment significantly reduces cure rates; removal is recommended whenever possible 1, 2
- While some studies have used lower doses (50-100 mg daily), more recent evidence supports a 200 mg daily dose for adequate treatment of symptomatic UTI 5, 6, 7
- Treatment should continue until clinical parameters or laboratory tests indicate that active fungal infection has subsided 4
- An inadequate period of treatment may lead to recurrence of active infection 4
- Fluconazole resistance may develop during therapy, particularly with C. glabrata; monitoring of clinical response is recommended 2