What is the treatment for a urine culture positive for Candida Albicans?

Treatment of Candida Albicans Candiduria

For asymptomatic candiduria caused by Candida albicans, treatment is NOT recommended unless the patient is at high risk for dissemination (neutropenic, very low birth weight infant <1500g, or undergoing urologic procedures). 1

Initial Assessment and Risk Stratification

First, eliminate predisposing factors—particularly remove indwelling bladder catheters if feasible, as this alone resolves candiduria in approximately 50% of asymptomatic patients. 1, 2

Confirm true candiduria by repeating the urine culture to exclude contamination before initiating any treatment. 3

Treatment Based on Clinical Presentation

Asymptomatic Candiduria (Most Common Scenario)

• No antifungal therapy is indicated for the vast majority of patients with asymptomatic candiduria. 1
• Remove urinary catheters and discontinue unnecessary antibiotics as the primary intervention. 1, 2

High-risk exceptions requiring treatment:

• Neutropenic patients: Treat as candidemia with echinocandin therapy (see candidemia guidelines). 1
• Very low birth weight infants (<1500g): Treat as disseminated candidiasis. 1
• Patients undergoing urologic procedures: Administer fluconazole 400 mg (6 mg/kg) daily OR amphotericin B deoxycholate 0.3-0.6 mg/kg daily for several days before and after the procedure. 1

Symptomatic Cystitis

For symptomatic cystitis caused by fluconazole-susceptible C. albicans, oral fluconazole 200 mg (3 mg/kg) daily for 14 days is the treatment of choice. 1

• Remove indwelling bladder catheters if present—this is strongly recommended and critical for treatment success. 1
• Alternative dosing from some guidelines suggests 400 mg loading dose on day 1, then 200 mg daily for 7-14 days. 3

Pyelonephritis

For pyelonephritis caused by fluconazole-susceptible C. albicans, oral fluconazole 200-400 mg (3-6 mg/kg) daily for 14 days is recommended. 1

• Eliminate urinary tract obstruction—this is strongly recommended and essential for cure. 1
• Consider removal or replacement of nephrostomy tubes or stents if present. 1
• If disseminated candidiasis is suspected with pyelonephritis, treat as candidemia with more aggressive systemic therapy. 1

Important Clinical Considerations

C. albicans is typically fluconazole-susceptible, making fluconazole the preferred agent due to excellent urinary concentrations achieved with oral formulation. 2, 4

Common pitfalls to avoid:

• Do not treat asymptomatic candiduria in non-high-risk patients—this leads to unnecessary antifungal exposure and potential resistance. 1
• Do not use echinocandins for urinary tract infections, as they fail to achieve adequate urine concentrations. 2
• Do not use newer azole agents (voriconazole, posaconazole) for isolated urinary candidiasis, as urinary concentrations are inadequate. 2

Duration of therapy: The standard 14-day course for symptomatic infections is based on guideline consensus, though some data suggest 7-10 days may be adequate for uncomplicated cystitis. 1, 3, 4