From the Guidelines
Fungal urinary tract infections (UTIs) should be treated with antifungal agents, not antibiotics.
Treatment Options
- For cystitis due to fluconazole-susceptible Candida species, oral fluconazole at a dosage of 200 mg daily for 2 weeks is recommended 1.
- For fluconazole-resistant organisms, AmB-d at a dosage of 0.3–0.6 mg/kg daily for 1–7 days or oral flucytosine at a dosage of 25 mg/kg 4 times daily for 7–10 days are alternatives 1.
- Fluconazole is the drug of choice for treating Candida UTI, as it achieves high concentrations in the urine and is effective in eradicating candiduria 1.
- AmB deoxycholate is active against most Candida species and achieves concentrations in the urine that exceed the MICs for most isolates, but its use is limited by the need for intravenous administration and toxicity 1.
Important Considerations
- The ability of the antifungal agent to achieve adequate concentrations in the urine is crucial for effective treatment 1.
- Removal of urinary catheters and other instruments can help prevent relapse and improve treatment outcomes 1.
- Surgical intervention may be necessary for fungus balls or other complications 1.
From the Research
Treatment Options for Fungal Urinary Tract Infections
- 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, 4, 5, 6.
- Fluconazole is the preferred treatment for Candida UTIs due to its safety, high concentrations in urine, and availability in both oral and intravenous formulations 2, 3, 5, 6.
- Amphotericin B may be used as an alternative treatment for Candida UTIs, especially in cases where fluconazole is not effective or cannot be used 2, 4, 6.
- Flucytosine is another option, but its use requires caution due to toxicity 2.
- Echinocandins and azoles that do not achieve measurable concentrations in urine are not recommended for the treatment of urinary tract infections 2, 5.
Key Considerations
- The presence of Candida in the urine does not necessarily indicate a urinary tract infection, and antifungal therapy is not always warranted 2, 3, 4, 5, 6.
- Removing predisposing factors, such as indwelling catheters and antibiotics, can clear candiduria in almost 50% of asymptomatic patients 5.
- Treatment is recommended only when funguria is symptomatic or in cases of fungal colonization when host factors increase the risk of fungemia 4, 6.