From the Guidelines
Treatment of male fungal urinary tract infections (UTIs) typically involves antifungal medications, with fluconazole being the first-line option, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- For uncomplicated cases, oral fluconazole 200 mg on day one followed by 100 mg daily for 7-14 days is recommended, as it achieves high concentrations in the urine and is effective against most Candida species, including Candida albicans 1.
- Removal of any urinary catheters is essential if present, as they serve as a reservoir for fungal organisms, and adequate hydration helps flush out the urinary system and speeds recovery 1.
- Alternative medications include itraconazole 200 mg twice daily for 7-14 days or amphotericin B for resistant cases, such as those caused by fluconazole-resistant Candida species like C. glabrata or C. krusei 1.
Special Considerations
- For severe or complicated infections, higher doses or longer treatment courses may be necessary, and treatment should be guided by the severity of the infection and the patient's underlying health status 1.
- For recurrent infections, identifying and addressing underlying risk factors such as diabetes, immunosuppression, or anatomical abnormalities is crucial, and treatment success should be confirmed with a follow-up urine culture after completing the antifungal regimen to ensure complete eradication of the infection 1.
- Fungal UTIs in men are less common than bacterial infections and often occur in patients with compromised immune systems, recent antibiotic use, or urinary tract instrumentation, and require prompt and effective treatment to prevent complications and improve outcomes 1.
From the Research
Treatment Options for Male Fungal UTI
- The treatment of fungal urinary tract infections (UTIs) depends on the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the agent 2, 3.
- Fluconazole is preferred for the treatment of Candida UTIs due to its safety, achievement of high concentrations in the urine, and availability in both an oral and intravenous formulation 2, 4, 5.
- Amphotericin B may be useful for Candida UTIs in selected patients, and flucytosine is concentrated in urine and has broad activity against Candida spp, but its use requires caution because of toxicity 2, 3.
- Irrigation of the bladder with antifungal agents has limited utility, but may be useful in combination with systemic antifungal agents for patients with fungus balls 2.
- Newer azole agents and echinocandins are not recommended for the treatment of urinary tract infections since they fail to achieve adequate urine concentrations 5.
Comparison of Treatment Options
- A study comparing amphotericin B bladder irrigations (ABBI) to fluconazole for the treatment of candiduria in intensive care unit patients found that ABBI was equally efficacious in achieving overall cure, and resulted in greater clearance of candiduria compared to fluconazole 6.
- The study also found that renal dysfunction predicted greater cure with ABBI therapy compared to fluconazole, suggesting that ABBI may be preferred over fluconazole in patients with renal dysfunction 6.
Considerations for Treatment
- Treatment is recommended only when funguria is symptomatic or in cases of fungal colonization when host factors increase the risk of fungemia 3, 5.
- Removing predisposing factors, such as indwelling catheters and antibiotics, will clear candiduria in almost 50% of asymptomatic patients 5.
- The choice of antifungal agent will depend on the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the agent 2, 3.