From the Guidelines
Fluconazole is the recommended treatment for fungal urinary tract infections (UTIs), particularly for uncomplicated cases, due to its effectiveness and high concentrations in the urine, as shown in the 2016 update by the Infectious Diseases Society of America 1.
Treatment Approach
The treatment approach for fungal UTIs depends on the severity and complexity of the infection. For uncomplicated fungal UTIs, fluconazole is typically recommended at a dose of 200 mg on the first day, followed by 100 mg daily for 7-14 days.
- The dosage and duration of treatment may vary depending on the severity of the infection and the patient's response to treatment.
- Alternative medications, such as itraconazole or amphotericin B, may be considered for resistant cases or in patients who are allergic to fluconazole.
- It is essential to stay well-hydrated, urinate frequently, and complete the full course of medication even if symptoms improve.
Important Considerations
- Fungal UTIs are most commonly caused by Candida species, particularly in individuals with diabetes, compromised immune systems, or those who have recently used antibiotics or catheters.
- If symptoms persist after treatment, further evaluation is necessary as some fungal infections can be resistant to first-line treatments or may indicate an underlying condition requiring additional management.
- The 2009 update by the Infectious Diseases Society of America also recommends fluconazole as the first-line treatment for Candida cystitis and pyelonephritis 1.
- However, the most recent and highest-quality study, which is the 2016 update, should be prioritized when making treatment decisions 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Fungal UTI Treatment Options
- The treatment of fungal UTIs depends on the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the agent 2, 3, 4.
- 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, 4.
- Flucytosine is concentrated in urine and has broad activity against Candida spp, but its use requires caution because of toxicity 2.
- Low-dose amphotericin B may be useful for Candida UTIs in selected patients 2, 3.
- The role of echinocandins and azoles that do not achieve measurable concentrations in the urine is not clear, with some case series noting success and others reporting failures 2, 4.
- Irrigation of the bladder with antifungal agents has limited utility, but may be useful in combination with systemic antifungal agents for fungus balls 2.
Alternative Treatment Options
- Voriconazole may be an alternative oral treatment for fluconazole-resistant urinary candidiasis, with studies showing effective urinary diffusion and clinical effectiveness 5, 6.
- Voriconazole has been shown to achieve adequate urine concentrations and exhibit strong correlation between urine and plasma concentrations 6.
- Therapeutic drug monitoring may be necessary to optimize in situ concentrations of voriconazole 6.
Patient Considerations
- Asymptomatic patients with candiduria do not always require antifungal therapy, and removal of predisposing factors such as indwelling catheters and antibiotics may clear candiduria in almost 50% of cases 3, 4.
- Neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures may require antifungal therapy even if asymptomatic 3.