Treatment of Candiduria with Urinary Frequency

Diagnostic Approach

Candiduria with symptoms like frequency suggests cystitis rather than mere colonization, requiring treatment in patients with urinary frequency, as suggested by the Infectious Diseases Society of America 1, 4
Diagnostic tests on urine often cannot differentiate colonization from infection, so symptoms guide treatment decisions, according to the Clinical Infectious Diseases guidelines 2
Imaging (ultrasound or CT) may be helpful to rule out structural abnormalities, hydronephrosis, or fungus ball formation in patients with candiduria, as recommended by the Clinical Infectious Diseases guidelines 2

The Infectious Diseases Society of America recommends fluconazole 200 mg (3 mg/kg) daily for 2 weeks as the first-line treatment for fluconazole-susceptible Candida species in patients with symptomatic candiduria and urinary frequency 1, 2, 3
Amphotericin B deoxycholate (AmB-d) 0.3-0.6 mg/kg daily for 1-7 days is recommended for fluconazole-resistant species, such as C. glabrata and C. krusei, as suggested by the Clinical Infectious Diseases guidelines 1, 2
Oral flucytosine 25 mg/kg 4 times daily for 7-10 days is an alternative treatment option for fluconazole-resistant species, according to the Clinical Infectious Diseases guidelines 1, 2

C. albicans is typically susceptible to fluconazole, while C. glabrata often requires alternative therapy due to fluconazole resistance, as noted by the Clinical Infectious Diseases guidelines 1, 2
Echinocandins and other azoles (besides fluconazole) have minimal excretion into urine and are generally ineffective for treating Candida UTI, according to the Clinical Infectious Diseases guidelines 2
Lipid formulations of amphotericin B do not achieve adequate urine concentrations and should not be used for treating Candida UTI, as recommended by the Clinical Infectious Diseases guidelines 2

The standard duration of treatment is 2 weeks for cystitis, as recommended by the Infectious Diseases Society of America and the Clinical Infectious Diseases guidelines 1, 2, 3
Treatment should continue until symptoms have resolved and urine cultures no longer yield Candida species, according to the Clinical Infectious Diseases guidelines 1

Treating asymptomatic candiduria in patients without risk factors for dissemination is not recommended, as suggested by the Clinical Infectious Diseases guidelines and the Praxis Medical Insights 2, 3
Using antifungal agents with poor urinary excretion (echinocandins, voriconazole) for lower urinary tract infections is not recommended, according to the Clinical Infectious Diseases guidelines 2
Overlooking the possibility of disseminated candidiasis in high-risk patients with candiduria is a common pitfall to avoid, as noted by the Praxis Medical Insights 3