From the Guidelines
Candidal pyelonephritis 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.
Treatment Overview
The treatment of candidal pyelonephritis depends on the susceptibility of the Candida species to antifungal agents.
- For fluconazole-susceptible organisms, fluconazole is the preferred treatment option.
- For fluconazole-resistant organisms, alternative treatments such as amphotericin B or flucytosine may be necessary.
Antifungal Therapy
The choice of antifungal therapy for candidal pyelonephritis is crucial in managing the infection effectively.
- Fluconazole is the most commonly used antifungal agent for treating candidal pyelonephritis, especially for fluconazole-susceptible organisms.
- Amphotericin B and flucytosine are alternative options for treating fluconazole-resistant organisms.
Duration of Treatment
The duration of treatment for candidal pyelonephritis typically ranges from 2 to 4 weeks, depending on the severity of the infection and the patient's response to treatment.
- The treatment should be continued until the patient's symptoms have resolved and follow-up cultures are negative for Candida species.
Special Considerations
In certain cases, such as obstruction or fungus ball formation, additional interventions like urinary drainage via catheter or nephrostomy tube may be necessary.
- The treatment approach should be individualized based on the patient's underlying medical conditions, such as diabetes or recent antibiotic use, and the presence of any complications.
Recent Guidelines
The Infectious Diseases Society of America has published guidelines for the management of candidiasis, including candidal pyelonephritis 1.
- These guidelines provide recommendations for the treatment of candidal pyelonephritis based on the latest evidence and expert opinion.
From the FDA Drug Label
Success by Site of Infection ... Kidney ... 2/2
The FDA drug label mentions candidal infection of the kidney, but it does not provide sufficient information to directly answer the question about candidal pyelonephritis. The answer to the question about candidal pyelonephritis cannot be determined from the provided drug label.
From the Research
Definition and Causes of Candidal Pyelonephritis
- Candidal pyelonephritis is a type of urinary tract infection caused by Candida species, which can lead to inflammation of the kidneys 2, 3.
- The infection can occur through hematogenous spread following candidemia or through the retrograde route via the urethra 2.
- Major risk factors for candidal pyelonephritis include diabetes mellitus, indwelling urinary catheters, use of broad-spectrum antibiotics, urinary obstruction, and admission to intensive care units 2.
Diagnosis and Treatment of Candidal Pyelonephritis
- The presence of Candida species in urine does not always warrant antifungal therapy, except in cases of symptomatic infections or in patients who are neutropenic, very low-birth-weight infants, or undergoing urologic procedures 2, 3.
- Fluconazole is the treatment of choice for symptomatic candidal pyelonephritis, as it achieves high urinary levels 2, 3, 4.
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 2.
- The optimal dose of fluconazole for the treatment of candidal pyelonephritis is a 200-mg loading dose followed by 100 mg/d for at least four days 4.
Antifungal Resistance and Biofilm Formation
- Biofilm formation is a relevant risk factor for mortality in candidemia, and antifungal resistance can occur in biofilms 5.
- Fluconazole has been shown to be effective against Candida biofilms in the presence of 50% human serum, while other antifungals such as amphotericin B and echinocandins may have decreased activity 5.
- The efficacy of antifungal agents can vary depending on the species of Candida and the presence of neutropenia or other underlying conditions 6.