From the Guidelines
Yeast in urine should be treated with fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks for fluconazole-susceptible organisms, as recommended by the Infectious Diseases Society of America 1. The treatment of yeast in urine, typically caused by Candida species, depends on the severity of the infection and the patient's underlying health conditions.
- For patients with cystitis due to fluconazole-susceptible Candida species, oral fluconazole is the recommended treatment 1.
- For patients with fluconazole-resistant organisms, alternative treatments such as AmB-d or oral flucytosine may be used 1.
- The duration of treatment should be until symptoms have resolved and urine cultures no longer yield Candida species 1.
- It is essential to manage predisposing conditions, such as removing indwelling bladder catheters, to prevent recurrence of yeast in urine 1.
- Patients undergoing urologic procedures should be treated with oral fluconazole or AmB deoxycholate for several days before and after the procedure to prevent infection 1.
- Neutropenic patients and very low-birth-weight infants should be treated as recommended for candidemia, with antifungal agents such as fluconazole or AmB-d 1. Key considerations in the treatment of yeast in urine include:
- The use of antifungal agents should be guided by susceptibility testing and local epidemiology 1.
- The treatment of yeast in urine should be individualized based on the patient's underlying health conditions and the severity of the infection 1.
- The prevention of yeast in urine includes avoiding douches, scented products in the genital area, wearing cotton underwear, and changing out of wet clothing promptly [@Example@].
- Maintaining good blood sugar control is essential for patients with diabetes, as high glucose levels promote yeast growth [@Example@].
From the FDA Drug Label
Fluconazole tablets are indicated for the treatment of: ... In open noncomparative studies of relatively small numbers of patients, fluconazole tablets were also effective for the treatment of Candida urinary tract infections, ...
The treatment for yeast in urine is fluconazole (PO), as it has been shown to be effective in treating Candida urinary tract infections 2.
- Key points:
- Fluconazole is indicated for the treatment of various fungal infections, including Candida urinary tract infections.
- The drug has been shown to be effective in open noncomparative studies.
From the Research
Treatment Options for Yeast in Urine
- The treatment of choice for symptomatic yeast infections in the urine is fluconazole, as it achieves high urinary levels 3, 4.
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 3.
- Other azole antifungals and echinocandins are not recommended for the treatment of urinary tract infections as they do not reach sufficient urine levels 3, 4.
- Removing predisposing factors, such as indwelling catheters and antibiotics, can clear candiduria in almost 50% of asymptomatic patients 4.
Risk Factors and Patient Groups
- Candiduria is commonly seen in hospitalized patients, particularly those with diabetes mellitus, indwelling urinary catheters, and those using broad-spectrum antibiotics 3, 5.
- Asymptomatic patients do not typically require antifungal therapy, except in cases of neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures 3.
- Symptomatic yeast infections in the urine can be caused by hematogenous spread or retrograde route via the urethra 3.
Additional Treatment Considerations
- Voriconazole has been shown to be effective in the treatment of candidaemia in non-neutropenic patients, with fewer toxic effects compared to amphotericin B/fluconazole 6.
- The treatment of fungal urinary tract infections may involve medical and surgical interventions, depending on the severity of the infection and the presence of complications such as fungus balls or renal abscesses 7, 5.