Treatment and Duration for Fungal Acute Cystitis

Introduction to Fungal Acute Cystitis Treatment

The Infectious Diseases Society of America recommends that treatment with antifungal agents is not indicated for fungal acute cystitis unless the patient belongs to a high-risk group for dissemination, which includes neutropenic patients, very low-birth-weight infants, or patients who will undergo urologic manipulation 1, 2, 3

For patients who do not require treatment, elimination of predisposing factors, such as indwelling bladder catheters, is recommended whenever feasible 1, 2, 3
Most immunocompetent patients with asymptomatic candiduria do not require antifungal therapy, as recommended by the Infectious Diseases Society of America 4, 5

For high-risk patients with fluconazole-susceptible organisms, such as C. albicans, the Infectious Diseases Society of America recommends oral fluconazole, 200 mg daily for 2 weeks 1, 2, 3
Removal of indwelling bladder catheter, if present, is strongly recommended for high-risk patients 1, 3

For fluconazole-resistant C. glabrata, treatment options include AmB 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, as recommended by the Infectious Diseases Society of America 1, 2, 3
For C. krusei infections, AmB deoxycholate, 0.3-0.6 mg/kg daily for 1-7 days, is recommended 1, 2, 3

For patients undergoing urologic procedures with fungal cystitis, the Infectious Diseases Society of America recommends oral fluconazole, 400 mg daily, or AmB deoxycholate, 0.3-0.6 mg/kg daily, for several days before and after the procedure 1, 2, 3

AmB deoxycholate bladder irrigation, 50 mg/L sterile water daily for 5 days, may be useful for treatment of cystitis due to fluconazole-resistant species, such as C. glabrata and C. krusei, as recommended by the Infectious Diseases Society of America 1, 2, 3

Surgical intervention, such as transurethral removal, is strongly recommended for fungus balls, along with systemic antifungal treatment and irrigation through nephrostomy tubes with AmB deoxycholate, as recommended by the Infectious Diseases Society of America 1, 2

Elimination of urinary tract obstruction is strongly recommended if present, and follow-up urine cultures are recommended to confirm eradication of infection, as recommended by the Infectious Diseases Society of America 1, 2, 6

Failure to remove or replace indwelling catheters may lead to persistent infection, and treating asymptomatic candiduria in non-high-risk patients is not recommended, as stated by the Infectious Diseases Society of America 1, 2, 3, 7
Always consider species identification and susceptibility testing when selecting therapy, as resistance patterns vary significantly among Candida species, as recommended by the Infectious Diseases Society of America 1, 2