Treatment of Fungal Urinary Tract Infection in Patients with Impaired Renal Function

Assessment and Treatment Approach

• The Infectious Diseases Society of America recommends that a finding of 50,000-100,000 yeast in urine represents a symptomatic fungal urinary tract infection requiring treatment 1, 2
• Oral fluconazole 200 mg daily for 2 weeks is the recommended treatment for fungal cystitis due to fluconazole-susceptible organisms, as it achieves high urinary concentrations in its active form 1, 2, 3

Alternative Treatments

• For fluconazole-resistant C. glabrata, the Infectious Diseases Society of America recommends Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days or oral flucytosine 25 mg/kg 4 times daily for 7-10 days 2, 3
• For C. krusei, the Infectious Diseases Society of America recommends Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 3

Additional Management Considerations

• The Infectious Diseases Society of America recommends removing any indwelling bladder catheter if present and ensuring adequate hydration to promote urinary flow 3, 4
• Repeat urinalysis and culture after completion of therapy to confirm eradication, and monitor renal function during treatment, especially if using amphotericin B 2, 4

Special Considerations

• If the patient develops pyelonephritis, the Infectious Diseases Society of America recommends increasing fluconazole to 200-400 mg daily for 2 weeks 3
• For patients with fungus balls, surgical intervention is strongly recommended along with antifungal therapy 3