Antimicrobial prescribing: NHS Lothian
- Blood cultures (if concerns of candidemia)
- Urine culture
- Urinary tract imaging
Candida UTI
Warning
Candida UTI can develop by 2 different routes. Most symptomatic UTIs evolve as an ascending infection beginning in the lower urinary tract, similar to the pathogenesis of bacterial UTI. Patients with ascending infection can have symptoms of cystitis or pyelonephritis. The other route of infection occurs as a consequence of hematogenous spread to the kidneys in a patient who has candidemia. These patients usually have no urinary tract symptoms or signs, and are treated for candidemia.
Consider those at increased risk when assessing the likelihood of candida UTI: diabetes, exposure to broad spectrum antibiotics and those receiving instrumentation of the urinary tract (e.g. ureteric stents).
Urology review is recommended.
Recommended total duration (oral and IV): 14 days
Symptomatic patients who have had stents inserted should receive 14 days post stent insertion.
For complicated candida UTI e.g. fungal balls/complex urology/severely immunocompromised, treatment duration may be extended (in conjunction with urology and infection specialist advice).
Isolated reported as susceptible 'S' to fluconazole:
- Fluconazole 800mg on first day, followed by 400mg daily (IV route only when oral route not available).
- For patients with BMI ≥ 30kg/m2, please discuss dosing with pharmacist. Use 12mg/kg (rounded to the nearest 50mg) loading dose and 6mg/kg (rounded to the nearest 50mg) maintenance dose. Maximum loading dose of 1200mg and maintenance dose usually around 600mg.
- Check drug interactions and monitor U+Es and LFTs at baseline and weekly thereafter. Dose adjustment required in renal impairment. ECG at baseline (fluconazole can prolong QT interval) and ECG monitoring as required.
- For patients with candida cystitis lower dosing of fluconazole may be used. Please discuss with pharmacy/microbiology.
Isolates reported as ‘I’ or ‘R’ to fluconazole:
- Please discuss with microbiology.
- See high dose guidance if high dose fluconazole recommended for isolates reported as ‘I’.
- For isolates resistant to fluconazole alternative agents may be recommended.