Management of Uncomplicated Candida Urinary Tract Infection in Renal Transplant Recipients

Antifungal Treatment Recommendations

• Fluconazole‑susceptible Candida species – Oral fluconazole 200 mg (≈3 mg/kg) once daily for 14 days is the standard regimen for symptomatic uncomplicated cystitis, supported by moderate‑quality evidence. 1, 2, 3
• Fluconazole‑resistant Candida (e.g., C. glabrata) – Either amphotericin B deoxycholate 0.3–0.6 mg/kg intravenously daily for 1–7 days or oral flucytosine 25 mg/kg four times daily for 7–10 days is recommended. 1, 2

Special Considerations for Renal Transplant Recipients

• Asymptomatic candiduria – Routine antifungal therapy is not indicated in renal‑transplant recipients unless they belong to a high‑risk group for hematogenous dissemination. 1, 4
• Symptomatic (non‑complicated) infection – Treatment follows the same cystitis recommendations applied to the general population (see above). 1, 2

Additional Management Measures

• Removal of indwelling urinary catheters – Prompt removal of permanent urinary catheters is strongly advised to reduce infection persistence and recurrence. 1, 2, 3
• Correction of urinary tract obstruction – Any obstructive uropathy should be addressed promptly to facilitate infection clearance. 1, 2

Diagnostic Guidance

• Antifungal susceptibility testing – Perform susceptibility testing on isolated Candida strains to direct appropriate antifungal selection and dosing. 5