Candiduria/Cystitis/Pyelonephritis
[Clin Infect Dis 2016;62:e1-50.]
- Candiduria usually associated with foreign body in urinary tract. Removal of urinary catheter or stent results in ~40% eradication of candiduria but only 20% eradication if catheter/stent subsequently reinserted.
- Persistent candiduria in immunocompromised patients warrants ultrasound or CT of kidney.
- Bladder irrigation with amphotericin B has been used to treat candidal cystitis but does not treat infections beyond the bladder and has a high relapse rate. May be useful for fluconazole resistant Candida species, e.g. C. krusei or C. glabrata.
- Note: Echinocandins and voriconazole have poor urinary concentrations and limited clinical data.
Asymptomatic
| Empiric Therapy | Duration | |
|---|---|---|
| Treatment not recommended unless high risk | ||
Symptomatic cystitis/pyelonephritis
| Empiric Therapy | Duration | |
|---|---|---|
| Fluconazole |
Cystitis: 200mg (3mg/kg) PO daily Pyelonephritis: 200-400mg (3-6mg/kg) PO daily |
14 days 14 days |
Alternative
| Empiric Therapy | Duration | |
|---|---|---|
| Amphotericin B | 0.3-0.6mg/kg IV daily | 1-7 days |