Fluconazole Dosing for Candiduria
For symptomatic candiduria with fluconazole-susceptible organisms, administer oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks for cystitis, or 200-400 mg (3-6 mg/kg) daily for 2 weeks for pyelonephritis. 1
When to Treat Candiduria
Most candiduria does not require antifungal treatment. Treatment is NOT recommended unless the patient belongs to a high-risk group including: 1
- Neutropenic patients
- Very low birth-weight infants (<1500 g)
- Patients undergoing urologic manipulation
Remove indwelling bladder catheters whenever feasible before initiating treatment—this alone resolves candiduria in nearly half of cases. 1, 2
Dosing by Clinical Presentation
Cystitis (Lower UTI)
- Fluconazole-susceptible organisms: 200 mg (3 mg/kg) daily for 2 weeks 1
- Loading dose approach: 400 mg on day 1, then 200 mg daily for 7-14 days 3
Pyelonephritis (Upper UTI)
- Fluconazole-susceptible organisms: 200-400 mg (3-6 mg/kg) daily for 2 weeks 1
- Higher doses (400 mg daily) are preferred for upper tract involvement 4
Patients Undergoing Urologic Procedures
- Prophylactic dosing: 400 mg (6 mg/kg) daily for several days before and after the procedure 1
- Alternative: Amphotericin B deoxycholate 0.3-0.6 mg/kg daily 1
Special Populations
Hemodialysis Patients
Administer 200 mg after each hemodialysis session rather than daily dosing, as fluconazole is removed during dialysis. 2, 4
Neutropenic Patients and Neonates
These high-risk groups should be treated as having candidemia with higher doses: fluconazole 12 mg/kg IV or oral daily. 1
Resistant Species
C. glabrata (Fluconazole-Resistant)
- Amphotericin B deoxycholate: 0.3-0.6 mg/kg daily for 1-7 days 1, 2
- Alternative: Oral flucytosine 25 mg/kg four times daily for 7-10 days 1, 2
C. krusei (Intrinsically Resistant)
- Amphotericin B deoxycholate: 0.3-0.6 mg/kg daily for 1-7 days 1, 2
- Do not use fluconazole—C. krusei has intrinsic resistance 4, 5
Critical Management Principles
Catheter removal is strongly recommended and significantly improves cure rates—continuing catheters during treatment substantially reduces efficacy. 1, 2, 4
Complete the full 2-week course—shorter durations lead to recurrence and treatment failure. 4
For complicated infections with fungal balls or urinary obstruction, surgical intervention is required in addition to antifungal therapy. 2
Common Pitfalls
- Treating asymptomatic candiduria in low-risk patients: This is unnecessary and promotes resistance 1
- Using echinocandins for urinary candidiasis: These agents achieve poor urinary concentrations and should be avoided 1
- Inadequate treatment duration: Minimum 2 weeks required for symptomatic UTI 4
- Assuming all Candida species respond to fluconazole: C. krusei is intrinsically resistant and C. glabrata has variable susceptibility 2, 4, 5