Fluconazole Dosing for Candiduria
For candiduria with fluconazole-susceptible organisms, the recommended dose is fluconazole 200 mg daily for 2 weeks, but treatment should only be initiated in high-risk patients after catheter removal when feasible. 1, 2
When to Treat Candiduria
Most candiduria does not require antifungal therapy. Treatment is indicated only for specific high-risk groups 1, 2:
- Neutropenic patients 1, 2
- Very low birth weight infants 1, 2
- Patients undergoing urologic manipulation or procedures 1, 2
- Symptomatic patients with cystitis or pyelonephritis 1, 3
Asymptomatic candiduria in otherwise healthy patients generally resolves spontaneously and does not require treatment 1.
First-Line Management: Catheter Removal
Remove indwelling bladder catheters before initiating antifungal therapy whenever possible, as this alone resolves candiduria in approximately 50% of cases. 1, 2
Continuing catheters during treatment significantly reduces cure rates 2. Confirm candiduria with a second urine culture to exclude contamination before proceeding with treatment 3.
Standard Dosing for Uncomplicated Candiduria
For fluconazole-susceptible Candida species (primarily C. albicans) 1, 4:
- Fluconazole 200 mg daily for 2 weeks 1, 2
- Daily doses of 50-200 mg have been used in clinical studies for urinary tract infections 4
Dosing for Complicated Urinary Candidiasis
For candida pyelonephritis without dissemination 1, 3:
- Fluconazole 200-400 mg daily for 2 weeks for susceptible organisms 1
- Alternative: Fluconazole 3-6 mg/kg/day for 14 days 3
For fungal balls or obstructive uropathy: Surgical intervention is required in addition to antifungal therapy 1.
Special Population: Dialysis Patients
For hemodialysis patients with candiduria 1:
- Fluconazole 200 mg administered after each hemodialysis session 1
- Continue for 2 weeks of treatment 1
The FDA label confirms that hemodialysis patients should receive 100% of the recommended dose after each dialysis session 4.
Resistant Organisms
For fluconazole-resistant C. glabrata 1:
- Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days, OR
- Oral flucytosine 25 mg/kg four times daily for 7-10 days 1
For C. krusei infections 1:
- Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1
Critical Pitfalls to Avoid
Catheter management: Leaving catheters in place during treatment dramatically reduces cure rates; removal is essential for treatment success 1, 2.
Resistance development: C. glabrata may develop fluconazole resistance during therapy; monitor clinical response closely and consider follow-up cultures if improvement is not observed 1, 2.
Premature treatment: Confirm candiduria with repeat culture before initiating therapy to avoid treating contamination 3.
Inadequate treatment duration: Complete the full 2-week course even if symptoms resolve earlier to prevent relapse 1, 2.