What is the appropriate treatment for a patient with a urinary tract infection (UTI) and yeast infection, presenting with pyuria (>50 white blood cells (WBC) per high power field), hematuria (6-10 red blood cells (RBC) per high power field), bacteriuria, and proteinuria (100 mg/dL)?

From the Guidelines

For a urinary tract infection (UTI) with concurrent yeast infection as indicated by your urinalysis results, I recommend a two-pronged treatment approach, prioritizing the most recent and highest quality study available 1.

Treatment Approach

• For the bacterial UTI, take nitrofurantoin (Macrobid) 100mg twice daily for 5-7 days or trimethoprim-sulfamethoxazole (Bactrim DS) one tablet twice daily for 3 days, as these are reasonable empirical treatment regimens for uncomplicated cystitis according to the guidelines for the prevention, diagnosis, and management of urinary tract infections 1.
• For the yeast infection, use fluconazole (Diflucan) 150mg as a single oral dose, as it is the drug of choice for treating Candida UTI and achieves high concentrations in the urine, making it effective against most Candida species 1.

Rationale

The urinalysis shows clear signs of both infections: elevated white blood cells (>50), bacteria, and positive leukocyte esterase indicate bacterial infection, while the presence of yeast confirms a fungal component.

• Completing the full course of antibiotics is crucial, even if symptoms improve quickly, to prevent recurrence.
• If symptoms worsen or don't improve within 48-72 hours, seeking medical attention is necessary, as a different antibiotic may be required based on culture results.
• Avoiding alcohol during treatment, especially with metronidazole if prescribed, is important, as it can cause severe reactions.

Additional Considerations

• Drinking plenty of water during treatment helps flush bacteria from the urinary tract.
• The guidelines for managing candidiasis support the use of fluconazole for Candida UTI, with alternatives such as flucytosine or amphotericin B deoxycholate considered in cases of fluconazole resistance or specific patient conditions 1.

From the FDA Drug Label

The determination of dosage for any particular patient must take into consideration the severity and nature of the infection, the susceptibility of the causative organism, the integrity of the patient’s host-defense mechanisms, and the status of renal function and hepatic function. Ciprofloxacin should be administered at least 2 hours before or 6 hours after magnesium/aluminum antacids, or sucralfate, Videx (didanosine) chewable/buffered tablets or pediatric powder for oral solution, other highly buffered drugs, or other products containing calcium, iron or zinc ADULT DOSAGE GUIDELINES Infection Severity Dose Frequency Usual Durations Uncomplicated Urinary Tract Infections Mild/Moderate 250 mg q 12 h 3 Days

Treatment for UTI and Yeast:

• The patient has a complicated urinary tract infection with many bacteria, yeast, and WBCs present in the urine.
• Ciprofloxacin 2 can be used to treat the bacterial infection, but the dosage and duration of treatment should be determined based on the severity of the infection and the patient's renal function.
• The presence of yeast in the urine may require additional treatment with an antifungal medication.
• It is essential to note that ciprofloxacin 2 may not be effective against yeast infections, and a different medication may be needed to treat the yeast infection.
• Amoxicillin-clavulanate 3 may also be used to treat the bacterial infection, but the dosage and duration of treatment should be determined based on the severity of the infection.

From the Research

Urinalysis Results

• WBC urine >50
• RBC urine 6-10
• Bacteria many
• Yeast urine present
• WBC clumps present
• Blood urine small
• Protein urine 100
• Motivate positive
• Leukocyte large

Treatment for UTI and Yeast

The treatment for UTI and yeast infection can be determined based on the urinalysis results and the patient's symptoms. According to the study 4, the recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam.

• For UTIs caused by antibiotic-resistant Gram-negative bacteria, second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones, and β-lactams, such as amoxicillin-clavulanate 4.
• For yeast infections, treatment options are not specified in the provided studies, but it is essential to note that yeast infections require antifungal treatment.
• The study 5 suggests that urine cultures should be obtained in complicated or upper UTIs, but not in simple and lower tract UTIs, unless the patient is pregnant.
• The study 6 emphasizes the importance of early diagnosis and appropriate therapy with antibiotics to prevent complicated UTI conditions such as urosepsis.
• The study 7 discusses the diagnosis, treatment, and prevention of UTI, highlighting the importance of considering antimicrobial resistance when choosing treatment options.
• The study 8 compares the efficacy and tolerability of ciprofloxacin and amoxycillin/clavulanic acid in the treatment of uncomplicated urinary tract infection, finding ciprofloxacin to be significantly more effective.