Oral Fluconazole Dosing for Candida kefyr UTI
For Candida kefyr urinary tract infection, treat with oral fluconazole 200 mg daily for 2 weeks, as this species is typically fluconazole-susceptible and follows the standard dosing regimen for susceptible Candida species. 1
Initial Assessment and Risk Stratification
Before initiating treatment, determine whether antifungal therapy is truly indicated:
- Treatment is only necessary if the patient belongs to a high-risk group (neutropenic patients, very low-birth-weight infants <1500g, or patients undergoing urologic manipulation), otherwise asymptomatic candiduria does not require treatment 1, 2
- Remove any indwelling bladder catheter immediately if present, as this alone resolves candiduria in nearly half of cases and is a strong recommendation 1, 2
Specific Dosing Regimen for C. kefyr
Since C. kefyr is generally fluconazole-susceptible (unlike C. krusei which has intrinsic resistance):
- Standard cystitis dosing: Fluconazole 200 mg (3 mg/kg) orally once daily for 2 weeks 1
- For pyelonephritis: Fluconazole 200-400 mg (3-6 mg/kg) orally once daily for 2 weeks 1
- No loading dose is specifically required for UTI, though the FDA label suggests a 400 mg loading dose on day 1 followed by 200 mg daily could be considered 3
Evidence Supporting This Approach
The IDSA guideline provides strong recommendations with moderate-quality evidence for the 200 mg daily dosing in fluconazole-susceptible organisms 1. This is corroborated by:
- A case series specifically documenting successful treatment of C. kefyr UTI with fluconazole 50-100 mg daily 4
- Multiple studies showing efficacy with 100-200 mg daily dosing for candidal UTIs 5, 6
- The FDA label confirming that 50-200 mg daily doses have been used for Candida UTIs 3
Special Populations
For dialysis patients: Administer the 200 mg maintenance dose after each hemodialysis session 2
For patients with severe renal impairment (CrCl <50 mL/min): Dose adjustment may be needed, though fluconazole achieves excellent urinary concentrations even with renal dysfunction 7
Critical Pitfalls to Avoid
- Do not withhold treatment if the patient has risk factors for dissemination (advanced age with leukocytosis suggests potential systemic spread) 8
- Continuing indwelling catheters during treatment significantly reduces cure rates—removal is essential whenever possible 2
- Ensure adequate treatment duration of 2 full weeks to prevent relapse, as inadequate treatment periods lead to recurrence 1, 3
- Verify susceptibility if available, as some non-albicans species may develop resistance during therapy 2