Candiduria: When and How to Treat It

The clinical finding of candiduria is often an enigmatic problem for the evaluating physician. The significance of yeast in the urine can range from procurement contamination to a sign of a life-threatening, opportunistic fungal infection. Proper evaluation requires validation of funguria, consideration of the setting in which it occurs, and the status of the patient. Provided that the patient is clinically stable, asymptomatic candiduria usually need not be treated with an antifungal agent. Rather, management should be directed at the elimination of predisposing factors, if feasible. When treatment is required, appropriate agents include amphotericin B (AmB), various lipid preparations of AmB (L-AmB), azoles, and flucytosine. Parenteral AmB is most useful against life-threatening infections in which the urinary tract is but one component of a widespread infection, or when resistant Candida are causative. Shorter courses of therapy may be preferable in certain cases. L-AmB treatment has been less sucessful. Intravesical AmB is a time-honored approach, but is best employed diagnostically rather than therapeutically. Fluconazole is presently the agent of first choice for susceptible fungi, but dosage and duration of therapy have not been established. Flucytosine is a useful alternative, especially for resistant Candida, but its toxicity must be closely monitored.