Fluconazole Dosing for Non-Albicans Candida Urinary Tract Infections

General Treatment Guidelines

• For fluconazole-susceptible non-albicans Candida urinary tract infections, the Infectious Diseases Society of America (IDSA) recommends oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks for cystitis, or 200-400 mg (3-6 mg/kg) daily for 2 weeks for pyelonephritis 1, 2
• The IDSA guidelines provide strong recommendations (strong recommendation; moderate-quality evidence) for fluconazole-susceptible cystitis 1

Special Populations

• For hemodialysis patients with fluconazole-susceptible organisms, the IDSA recommends administering fluconazole 200 mg after each hemodialysis session, although this specific recommendation is from Praxis Medical Insights 4
• Neutropenic patients and very low birth weight infants <1500g with candiduria should be treated as having candidemia, according to the IDSA 1, 2

Treatment of Specific Candida Species

• C. krusei is intrinsically resistant to fluconazole, and the IDSA recommends using amphotericin B for C. krusei infections 1, 2
• For fluconazole-resistant C. glabrata, the IDSA recommends 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 1, 2, 4

Prevention of Treatment Failure

• Removing indwelling catheters is strongly recommended and significantly improves cure rates, according to the IDSA 1, 4
• Minimum 2 weeks of therapy is required for symptomatic UTI, and shorter courses lead to recurrence 1, 2, 3