Antifungal choice for UTI caused by Candida and related species in adults
Fluconazole achieves a high urine concentration and is the drug of choice for treating noninvasive urinary tract infection (UTI) caused by Candida and related species. Other azoles (eg posaconazole, voriconazole) are minimally excreted in the urineKeighley, 2021. If the isolate is resistant to fluconazole, seek expert advice.
Amphotericin B deoxycholate1 achieves an adequate urine concentration and is active against most Candida and related species; however, lipid formulations of amphotericin B may not achieve an adequate urine concentration.
Echinocandins are minimally excreted into the urine; however, there are reports of their successful use in the treatment of candiduria and UTI caused by Candida and related speciesGabardi, 2016Rkieh, 2022.
Flucytosine is mostly excreted unchanged in urine and achieves high urinary concentrations but is usually given in combination as resistance can develop when it is used as monotherapyVermes, 2000.
If a urinary tract source of invasive candidaemia is suspected, see Overview of initial therapy for candidaemia for management advice.