What is the treatment for Candida albicans in urine?

Treatment of Candida Albicans in Urine

Fluconazole 200 mg (3 mg/kg) daily for 2 weeks is the treatment of choice for symptomatic Candida albicans urinary tract infections. 1

When to Treat vs. Observe

• Most patients with candiduria are colonized and do not require antifungal therapy 2
• Treatment is indicated for:
  • Symptomatic cystitis or pyelonephritis 1
  • Neutropenic patients 3
  • Patients undergoing urologic procedures 1
  • Very low-birth-weight infants 3
• Removing predisposing factors (indwelling catheters, antibiotics) clears candiduria in almost 50% of asymptomatic patients 2

First-Line Treatment Algorithm

For Fluconazole-Susceptible C. albicans (Most Common)

• Oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks 1
• Fluconazole is preferred because it achieves high urinary concentrations, has both oral and IV formulations, and has proven effectiveness in controlled trials 1, 4
• Continue treatment until symptoms resolve and urine cultures clear 5

For Patients Undergoing Urologic Procedures

• 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

Alternative Agents (When Fluconazole Cannot Be Used)

• Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days for fluconazole-resistant organisms, allergy, or treatment failure 1, 3
• Flucytosine 25 mg/kg four times daily for 7-10 days has good activity but carries toxicity concerns and resistance risk when used alone 1

Critical Management Steps Beyond Antifungals

• Remove or replace urinary catheters, nephrostomy tubes, or stents if feasible 1, 5
• Eliminate urinary tract obstruction as this is critical to treatment success 5
• Obtain imaging if infection persists despite appropriate therapy to rule out anatomical abnormalities or fungus balls 5

Common Pitfalls to Avoid

• Do NOT use echinocandins for lower urinary tract infections - they achieve minimal urinary concentrations and are generally ineffective 5, 2
• Do NOT use lipid formulations of amphotericin B - they do not achieve adequate urine concentrations 5
• Do NOT use other azoles besides fluconazole (voriconazole, posaconazole) for UTIs as they fail to achieve adequate urine levels 2, 4
• Colony count cannot reliably differentiate colonization from infection, especially with catheters present 1
• Bladder irrigation with amphotericin B resolves candiduria in 80-90% but has high recurrence rates and is generally discouraged except for refractory azole-resistant cystitis 6, 1

Special Situations

Candida Pyelonephritis

• Fluconazole remains the drug of choice for renal parenchymal infection 6
• Amphotericin B deoxycholate may be needed for resistant species 6

Fungus Balls

• Require aggressive surgical debridement as central treatment 6
• Systemic amphotericin B or fluconazole plus local irrigation through nephrostomy tube (amphotericin B 50 mg/L sterile water) 6, 7