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Updated August 2009 by Charles Gomersall
Candiduria usually represents only colonization although it may reflect
systemic candidiasis and in patients with an obstructed urinary tract candiduria
may be the source for systemic dissemination.
Asymptomatic candiduria
- rarely requires treatment but it should be noted
that candiduria may be the only microbiological documentation of
disseminated candidiasis
- should be treated in:
- symptomatic patients
- neutropaenic patients
- low birth weight infants
- patients with renal allografts
- patients who will undergo urological manipulations
- 7-14 day courses recommended
- removal of urinary tract instruments (eg stents, Foley catheters) often
helpful. If complete removal not possible placing a new device may be
helpful
Regimes
- fluconazole 200-400 mg/day
- amphotericin B 0.3-1 mg/kg/day
- theoretical risk that use of lipid associated formulation, which is
designed to reduce nephrotoxicity, may result in decreased delivery of
amphotericin to site of action in urinary tract
- consider oral flucytosine 25 mg/kg 6 hourly for non-albicans Candida
in the absence of renal dysfunction
- emergence of resistance may occur rapidly when flucytosine used as
single agent
- bladder irrigation with amphotericin may transiently clear funguria but is
rarely indicated
Symptomatic candiduria
Cystitis
- fluconazole susceptible species: oral fluconazole 200mg daily for 2
weeks
- fluconazole resistant: amphotericin B 0.3-0.6 mg/kg daily for 1-7 days
or oral flucytosine 25 mg/kg 4 times daily for 7-10 days
- amphotericin B bladder irrigation generally not recommended but may be
useful for fluconazole resistant species, especially C. glabrata
Pyelonephritis
- Oral fluconazole 200-400 mg daily for 2 weeks
- Fluconazole resistant species (especially C. glabrata):
- amphotericin B 0.5-0.7 mg/kg daily ± flucytosine OR
- flucytosine alone 25 mg/kg 4 times daily
- 2 weeks treatment
Fungus balls
- surgical intervention (except neonates)
- fluconazole 200-400 mg daily OR
- amphotericin B 0.5-0.7 mg/kg daily ± flucytosine 25 mg/kg 4 times daily
- if access to renal collecting system available adjunctive therapy using
irrigation with amphotericin (50mg/l) in sterile water
- continue treatment until symptoms resolve and urine cultures negative
Further reading
Pappas PG. Guidelines for treatment of candidiasis:
2009 update by Infectious Diseases Society of Ameria. Clin
Infect Dis 2009; 48:503-535
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