From the Guidelines
For the treatment of fungal urinary tract infections, particularly those caused by Candida species, oral fluconazole is recommended at a dose of 200 mg (3 mg/kg) daily for 2 weeks. This recommendation is based on the clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America 1. The guideline suggests that this dosage is suitable for fluconazole-susceptible organisms, which are commonly the cause of fungal UTIs.
Key points to consider when prescribing fluconazole for UTIs include:
- The dosage of 200 mg (3 mg/kg) daily is recommended for 2 weeks for fluconazole-susceptible organisms 1.
- Removal of an indwelling bladder catheter, if feasible, is strongly recommended to help manage the infection 1.
- It is essential to note that fluconazole is not typically the first-line treatment for UTIs, as most UTIs are caused by bacteria, not fungi.
- The treatment duration and dosage may need to be adjusted based on the patient's clinical response, the severity of the infection, and the presence of any underlying conditions, such as renal impairment.
In clinical practice, it is crucial to select the appropriate antifungal therapy based on the susceptibility of the fungal organism and the severity of the infection. For fluconazole-resistant species, such as C. glabrata and C. krusei, alternative treatments may be necessary, as outlined in the guideline 1.
From the Research
Dosage of Fluconazole for Urinary Tract Infection (UTI)
- The dosage of fluconazole for UTI varies across different studies, with some studies recommending a dose of 50 mg per day 2, while others suggest a loading dose of 200 mg followed by 100 mg/day for at least four days 3.
- A study published in 1997 recommends a dose of 100 mg of fluconazole followed by 50 mg/day for 14 days 4.
- Another study published in 1995 used doses of 50 to 100 mg/day for 2 to 4 weeks to treat urinary candidiasis 5.
- The choice of dosage may depend on the severity of the infection, the presence of underlying conditions, and the susceptibility of the fungal strain to fluconazole 3, 4, 5.
- It is worth noting that fluconazole is the antifungal agent of choice for treating Candida urinary tract infections, due to its ability to achieve high urine concentrations with oral formulation 6.