Treatment of Candida kefyr Urinary Tract Infection
Treat Candida kefyr urinary tract infection with oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks, as this species is typically fluconazole-susceptible and responds well to standard therapy. 1, 2
First-Line Treatment Approach
- Fluconazole is the drug of choice for Candida kefyr UTI at a dose of 200 mg (3 mg/kg) daily for 2 weeks 1
- This recommendation is based on fluconazole's high urinary concentrations, oral formulation availability, and proven effectiveness in treating Candida urinary infections 1, 3
- Clinical evidence specifically demonstrates successful eradication of C. kefyr from urine using fluconazole 50-100 mg/day for 2-4 weeks, with an 88% overall success rate in candiduria treatment 2
Critical Management Steps Beyond Antifungals
- Remove or replace urinary catheters if present, as catheter removal alone clears candiduria in nearly 50% of asymptomatic patients 1, 4
- Eliminate any urinary tract obstruction, including consideration of nephrostomy tube or stent removal/replacement if feasible 1, 5
- Discontinue broad-spectrum antibiotics when possible, as this is a significant modifiable risk factor 3, 6
When to Consider Alternative Therapy
- If fluconazole resistance is documented (rare for C. kefyr), switch to amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1, 3
- For patients undergoing urologic procedures, increase fluconazole to 400 mg (6 mg/kg) daily for several days before and after the procedure 1
- In cases of persistent infection despite appropriate fluconazole therapy, obtain imaging to rule out anatomical abnormalities, fungus balls, or pyelonephritis 5, 7
Important Clinical Caveats
- Do not use echinocandins or other azoles (besides fluconazole) for lower urinary tract infections, as they achieve minimal urinary excretion and are ineffective 5, 4
- Avoid lipid formulations of amphotericin B, which do not achieve adequate urine concentrations 5
- Colony counts cannot reliably differentiate colonization from infection, especially with catheters present—base treatment decisions on symptoms and clinical context 1
- Monitor for clinical improvement and obtain follow-up urine cultures to confirm clearance 5
Special Considerations for High-Risk Patients
- Treat asymptomatic candiduria in neutropenic patients, very low-birth-weight infants, and those undergoing urologic procedures 3
- For neonates or patients with anatomical abnormalities (such as vesicoureteral reflux), systemic therapy may need to be prolonged up to 3 months, and consider bladder instillation of amphotericin B as adjunctive therapy in refractory cases 7