From the Guidelines
Candida urinary tract infections (UTIs) should be treated with antifungal medications, with fluconazole being the first-line treatment for fluconazole-susceptible Candida species, at a dosage of 200 mg (3 mg/kg) daily for 2 weeks 1. When it comes to treating Candida UTIs, the primary goal is to eliminate the infection while minimizing the risk of complications and improving the patient's quality of life.
- The treatment approach may vary depending on the severity of the infection, the patient's underlying health conditions, and the susceptibility of the Candida species to antifungal agents.
- For patients with fluconazole-resistant Candida species, alternative treatments such as amphotericin B deoxycholate (AmB-d) or flucytosine may be considered 1.
- It is essential to note that the 2016 update by the Infectious Diseases Society of America recommends eliminating predisposing factors, such as indwelling bladder catheters, and treating high-risk patients, including neutropenic patients, very low-birth-weight infants, and patients undergoing urologic manipulation 1.
- However, the most recent and highest quality study, which is the 2016 update, should be prioritized, and according to this study, treatment with antifungal agents is NOT recommended unless the patient belongs to a group at high risk for dissemination 1.
- In clinical practice, the decision to treat Candida UTIs should be made on a case-by-case basis, taking into account the patient's individual risk factors and the potential benefits and risks of antifungal therapy.
- Patients should be advised to increase fluid intake to help flush out the fungus and complete the full medication course even if symptoms improve.
- Removal of urinary catheters is essential if present, as they serve as reservoirs for infection.
- Candida UTIs occur when the fungus, normally present in the body, overgrows in the urinary tract, often due to immunosuppression, diabetes, recent antibiotic use, or catheterization.
- Unlike bacterial UTIs, over-the-counter remedies are ineffective, and proper antifungal treatment is necessary.
From the Research
Treatment Options for Candida UTI
- The treatment of choice for symptomatic Candida urinary tract infections (UTIs) is fluconazole, due to its safety, high concentrations in urine, and availability in both oral and intravenous formulations 2, 3, 4.
- Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 2.
- Flucytosine is concentrated in urine and has broad activity against Candida spp, but its use requires caution due to toxicity 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 noting failures 3.
Duration of Antifungal Treatment
- The Infectious Diseases Society of America guidelines recommend 14 days of treatment for Candida spp. urinary tract infections (UTIs) 5.
- However, a recent study found no difference in clinical treatment success between patients treated with fluconazole for 14 days and those treated for less than 14 days 5.
- The study suggests that shorter antifungal durations may be effective for symptomatic Candida spp. UTI, but further research is needed to confirm this finding 5.
Alternative Treatment Options
- Amphotericin B bladder irrigations (ABBI) may be considered an alternative to fluconazole for the treatment of candiduria, particularly in patients with renal dysfunction 6.
- ABBI was found to be equally efficacious in achieving overall cure and resulted in greater clearance of candiduria compared to fluconazole in one study 6.
- However, the use of ABBI is not widely recommended and more research is needed to determine its effectiveness and safety 6.