10
Management
XIV. Urinary Tract Infections Due to Candida Species
Asymptomatic Candiduria
Î Elimination of predisposing factors, such as indwelling bladder
catheters, is recommended whenever feasible (S/L).
Î Treatment with antifungal agents is not recommended unless the
patient belongs to a group at high risk for dissemination. High-risk
patients include neutropenic patients, very low birth weight infants
(<1500 grams), and patients who will undergo urologic manipulation
(S/L).
Î Neutropenic patients and very low birth weight infants should be
treated as recommended for candidemia [see Sections III and VII
(S/L).
Î Patients undergoing urologic procedures should be treated with
oral fluconazole, 400 mg (6 mg/kg) daily, OR AmB deoxycholate,
0.3-0.6 mg/kg daily, for several days before and after the procedure
(S/L).
Symptomatic Candida Cystitis
Î For fluconazole-susceptible organisms, oral fluconazole, 200 mg
(3 mg/kg) daily for 2 weeks is recommended (S/M).
Î For fluconazole-resistant C. glabrata, AmB deoxycholate, 0.3-0.6 mg/kg
daily for 1-7 days OR oral flucytosine, 25 mg/kg 4 times daily for 7-10
days is recommended (S/L).
Î For C. krusei, AmB deoxycholate, 0.3-0.6 mg/kg daily, for 1-7 days is
recommended (S/L).
Î Removal of an indwelling bladder catheter, if feasible, is strongly
recommended (S/L).
Î AmB deoxycholate bladder irrigation, 50 mg/L sterile water daily for
5 days, may be useful for treatment of cystitis due to fluconazole-
resistant species, such as C. glabrata and C. krusei (W/L).
Symptomatic Ascending Candida Pyelonephritis
Î For fluconazole-susceptible organisms, oral fluconazole, 200-400 mg
(3-6 mg/kg) daily for 2 weeks is recommended (S/L).
Î For fluconazole-resistant C. glabrata, AmB deoxycholate,
0.3-0.6 mg/kg daily for 1-7 days with or without oral flucytosine,
25 mg/kg 4 times daily, is recommended (S/L).
Î For fluconazole-resistant C. glabrata, monotherapy with oral flucytosine,
25 mg/kg 4 times daily for 2 weeks, could be considered (W/L).
