Symptomatic UTI caused by Candida and related species in adults
Symptomatic urinary tract infection (UTI) caused by Candida and related species is uncommon. In addition to antifungal therapy, management requires relief of any urinary tract obstruction, and removal of urinary catheters, stents or nephrostomy tubes if present.
Symptoms of acute cystitis caused by Candida and related species include acute dysuria, frequency, urgency and suprapubic tendernessKauffman, 2014. For cystitis caused by fluconazole-susceptible Candida and related species in adults, useKeighley, 2021Pappas, 2016:
fluconazole 200 mg orally, daily for 14 days. For dosage adjustment in adults with kidney impairment, see fluconazole dosage adjustment. fluconazole fluconazole fluconazole
Symptoms of acute pyelonephritis caused by Candida and related species include flank pain and fever (38°C or higher); symptoms of cystitis may be absentKauffman, 2014. For pyelonephritis caused by fluconazole-susceptible Candida and related species in adults, useKeighley, 2021Pappas, 2016:
fluconazole 800 mg orally on day 1, followed by fluconazole 400 mg orally, daily for a total of 14 days. For dosage adjustment in adults with kidney impairment, see fluconazole dosage adjustment. fluconazole fluconazole fluconazole
For symptomatic UTI caused by fluconazole-resistant Candida and related species, treatment options include amphotericin B deoxycholate1 and flucytosine – seek expert advicePappas, 2016.
If symptomatic UTI caused by Candida and related species is associated with a fungus ball, endoscopic or surgical removal of the fungus ball is required for successful treatment. Treat patients with the regimen for symptomatic pyelonephritis caused by Candida and related species (see above) and seek expert advice.
If a nephrostomy tube is present, seek expert advice.
If a urinary tract source of invasive candidaemia is suspected, see Overview of initial therapy for candidaemia for management advice.