Treatment of Urinary Yeast Infection in Males

Initial Assessment and Risk Stratification

The Infectious Diseases Society of America recommends that most asymptomatic candiduria does not require treatment unless the patient is neutropenic, a very low-birth-weight infant, or undergoing urologic procedures 1, 4
Removing predisposing factors first, such as indwelling catheters and unnecessary antibiotics, can clear candiduria in approximately 50% of asymptomatic patients 1, 4
High-risk patients requiring treatment include those with neutropenia, symptoms of cystitis/pyelonephritis, or planned urologic manipulation 1, 3, 4

The Infectious Diseases Society of America recommends oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks for fluconazole-susceptible organisms 1, 2, 3, 5, 6, 7
Catheter removal is mandatory if feasible 1, 2, 4
For C. glabrata (fluconazole-resistant), Amphotericin B deoxycholate 0.3–0.6 mg/kg daily for 1–7 days OR oral flucytosine 25 mg/kg four times daily for 7–10 days can be used 1, 2, 3
For C. krusei, Amphotericin B deoxycholate 0.3–0.6 mg/kg daily for 1–7 days can be used 1, 2, 3

The Infectious Diseases Society of America recommends oral fluconazole 200–400 mg (3–6 mg/kg) daily for 2 weeks for fluconazole-susceptible organisms 1, 2, 4, 5, 6, 7
Eliminate urinary tract obstruction (nephrostomy tubes, stents) - remove or replace if feasible 1, 2, 4
For fluconazole-resistant C. glabrata, Amphotericin B deoxycholate 0.3–0.6 mg/kg daily for 1–7 days with or without oral flucytosine 25 mg/kg four times daily can be used 1, 2, 4
Flucytosine monotherapy (25 mg/kg four times daily for 2 weeks) can be considered as a weaker alternative 1, 2

Surgical intervention is strongly recommended 1, 2, 4, 5, 6, 7
Systemic antifungal therapy: Fluconazole 200–400 mg (3–6 mg/kg) daily OR Amphotericin B deoxycholate 0.5–0.7 mg/kg daily with or without flucytosine 25 mg/kg four times daily 5, 6, 7
Local irrigation with Amphotericin B (25–50 mg in 200–500 mL sterile water) through nephrostomy tubes if present can be used 1, 2

Prophylactic treatment: Oral fluconazole 400 mg (6 mg/kg) daily OR Amphotericin B deoxycholate 0.3–0.6 mg/kg daily for several days before and after the procedure can be used 1, 3, 4, 5, 6, 7

Do not treat asymptomatic candiduria in immunocompetent patients, as this leads to unnecessary antifungal exposure and potential resistance 1, 4
Failure to remove catheters significantly reduces treatment success - catheter removal is as important as antifungal therapy 1, 2, 4
Bladder irrigation alone has high relapse rates and should only be used as adjunctive therapy for refractory resistant organisms 1, 2, 8