From the Guidelines
For an 88-year-old male with yeast in the urine, treatment typically involves oral fluconazole 200mg on day 1, followed by 100mg daily for 7-14 days, as recommended by the Infectious Diseases Society of America 1. This approach is based on the most recent guidelines, which prioritize fluconazole as the drug of choice for treating Candida UTI due to its effectiveness in eradicating candiduria and achieving high concentrations in the urine 1. Key considerations in managing candiduria include:
- Removing or replacing urinary catheters, if present, to prevent fungal colonization
- Increasing fluid intake to 2-3 liters per day, unless contraindicated, to help flush the urinary tract
- Addressing underlying risk factors, such as controlling blood sugar in diabetes or minimizing unnecessary antibiotic use, to prevent recurrent episodes
- Regular follow-up urine cultures to ensure clearance of the infection
- Further evaluation for potential structural abnormalities or systemic candidiasis if symptoms persist despite treatment, as recommended by the guidelines 1. It is essential to note that the treatment approach may vary depending on the specific circumstances, such as the presence of fluconazole-resistant Candida species or underlying medical conditions, and should be guided by the most recent and highest-quality evidence, such as the 2016 update by the Infectious Diseases Society of America 1.
From the Research
Treatment Options for Yeast in Urine
- For an 88-year-old male with yeast in urine, the treatment options depend on whether the patient is symptomatic or asymptomatic 2, 3.
- If the patient is asymptomatic, treatment is not usually necessary, except in cases of neutropenia, very low-birth-weight infants, or patients undergoing urologic procedures 2.
- For symptomatic infections, fluconazole is the treatment of choice, as it achieves high urinary levels 2, 3, 4.
Fluconazole Dosage
- The recommended dosage of fluconazole for symptomatic fungal urinary tract infection is a 200-mg loading dose followed by 100 mg/d for at least four days 4.
- However, the optimal dosing of fluconazole may vary depending on the species of Candida and the patient's renal function 4.
Alternative Treatment Options
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 2.
- Amphotericin B bladder irrigations (ABBI) may also be considered as an alternative to fluconazole, especially in patients with renal dysfunction 5.
- Voriconazole is an important agent in the antifungal armamentarium, but its use is not typically recommended for urinary tract infections due to its unpredictable pharmacokinetics and potential adverse effects 6.