Fluconazole Dosing for Yeast UTI

For symptomatic yeast cystitis with fluconazole-susceptible organisms, treat with oral fluconazole 200 mg (3 mg/kg) daily for 14 days. 1

Initial Assessment and Risk Stratification

Before initiating treatment, determine whether antifungal therapy is actually indicated, as most candiduria does not require treatment:

Remove indwelling urinary catheters immediately if present, as this alone resolves candiduria in approximately 40-50% of cases and is the single most important intervention. 1, 2
Asymptomatic candiduria generally should NOT be treated unless the patient falls into high-risk categories: neutropenic patients, very low birth weight infants (<1500g), or patients undergoing urologic procedures. 1, 2
High-risk patients require different management: neutropenic patients and very low birth weight infants should be treated as candidemia (not simple UTI), while patients undergoing urologic manipulation need prophylactic fluconazole 400 mg (6 mg/kg) daily for several days before and after the procedure. 1

Fluconazole 200 mg (3 mg/kg) orally once daily for 14 days for fluconazole-susceptible organisms (strong recommendation; moderate-quality evidence). 1, 3

Fluconazole 200-400 mg (3-6 mg/kg) orally once daily for 14 days for fluconazole-susceptible organisms without suspected dissemination. 1, 3
If disseminated candidiasis is suspected with pyelonephritis, treat as candidemia with higher doses. 1

Hemodialysis patients:

Administer fluconazole 200 mg after each hemodialysis session (typically 3 times weekly) for the 2-week treatment course. 2, 3

Peritoneal dialysis patients:

Use 50 mg intraperitoneally or 100 mg orally for treatment of fungal peritonitis. 4

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, 2, 3
C. glabrata may develop resistance during fluconazole therapy; monitor clinical response closely. 2

Standard fluconazole dosing as above applies. 1
The MIC90 for C. albicans is typically 12 mcg/mL, well within achievable urinary concentrations. 5

Continuing indwelling catheters during treatment significantly reduces cure rates—removal is mandatory whenever feasible. 2, 3
Treating asymptomatic candiduria in non-high-risk patients wastes resources and promotes resistance without improving outcomes. 1
Inadequate treatment duration (<2 weeks) leads to recurrence; the full 14-day course is essential for symptomatic UTI. 1, 3
Assuming all Candida species are fluconazole-susceptible is dangerous—obtain species identification and susceptibility testing, particularly for C. glabrata and C. krusei. 2, 3
Failing to evaluate for disseminated disease in high-risk patients (neutropenic, very low birth weight infants) can result in inadequate treatment, as these patients require candidemia-level therapy, not simple UTI dosing. 1

Fungal balls or obstructive uropathy require surgical intervention in addition to antifungal therapy. 2
Medical therapy alone is insufficient when mechanical obstruction is present. 2