What is the treatment for a Candida UTI?

Treatment of Candida Urinary Tract Infection

For symptomatic Candida UTI with fluconazole-susceptible organisms, treat with oral fluconazole 200 mg daily for 2 weeks, and remove any indwelling urinary catheter if present. 1

Initial Assessment and Treatment Decision

• Distinguish colonization from infection before initiating therapy, as candiduria often represents asymptomatic colonization that does not require treatment 2, 3
• Treat symptomatic patients presenting with dysuria, urgency, frequency, or fever with pyuria and high colony counts 4
• Always treat neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures, even if asymptomatic 3

First-Line Treatment Algorithm by Candida Species

Fluconazole-Susceptible Organisms (Most Common)

• For cystitis: Fluconazole 200 mg (3 mg/kg) orally daily for 2 weeks 1
• For pyelonephritis: Fluconazole 200-400 mg (3-6 mg/kg) orally 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 5, 2

Fluconazole-Resistant C. glabrata

• For cystitis: Amphotericin B deoxycholate 0.3-0.6 mg/kg IV daily for 1-7 days OR flucytosine 25 mg/kg orally 4 times daily for 7-10 days 1
• For pyelonephritis: Amphotericin B deoxycholate 0.3-0.6 mg/kg IV daily for 1-7 days with or without flucytosine 25 mg/kg orally 4 times daily 1
• Consider amphotericin B bladder irrigation (50 mg/L sterile water daily for 5 days) for cystitis, though recurrence rates are high 1

C. krusei

• Amphotericin B deoxycholate 0.3-0.6 mg/kg IV daily for 1-7 days for both cystitis and pyelonephritis 1, 5

Critical Adjunctive Measures

• Remove indwelling bladder catheters whenever feasible—this is strongly recommended and often leads to spontaneous resolution 1
• Eliminate urinary tract obstruction in all cases of pyelonephritis 1
• Remove or replace nephrostomy tubes or stents if present and feasible 1, 5

Common Pitfalls to Avoid

• Do not use echinocandins (caspofungin, micafungin, anidulafungin) for lower urinary tract infections—they achieve minimal urinary concentrations and are ineffective for Candida cystitis 6, 2
• Do not use lipid formulations of amphotericin B—they do not achieve adequate urine concentrations 6
• Do not use other azoles (itraconazole, voriconazole, posaconazole) for UTI—they have poor urinary excretion 6
• Do not rely on colony counts alone to differentiate infection from colonization, especially with catheters in place 5

Special Considerations for Urologic Procedures

• 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 5

Monitoring and Duration

• Continue treatment until symptoms resolve and urine cultures no longer yield Candida species 6
• Minimum 14 days after last positive culture for candidemia or invasive disease 1
• Obtain follow-up urine cultures to confirm clearance 6
• Consider imaging if infection persists despite appropriate therapy to rule out fungus balls or anatomical abnormalities 6