Oral fluconazole for Candida urinary tract infection

Fungal urinary tract infections are increasingly prevalent in hospitalized patients. This trial compares the efficacy of oral fluconazole along with catheter replacement to that of catheter replacement alone for treatment of funguria. The study group patients (n = 30) were given 100 mg of fluconazole followed by 50 mg/day for 14 days and had their catheters replaced on day one. The control group, randomized on a 1:1 basis (n = 30) had only a catheter replacement. Seventeen and 21 patients in the study and control groups, respectively, had Candida albicans, 8 and 5 had Candida tropicalis, and 5 and 4 had Candida glabrata. The MICs of the organisms were determined by the E test. The MIC90 of the C. albicans, C. tropicalis, and C. glabrata were 12, 16, and 64 micrograms/ml, respectively. Funguria disappeared in all study group patients within a week but recurred in only 1 patient 8 weeks after enrollment in the study. Although fluconazole caused a more rapid and an almost complete eradication of funguria and urinary WBCs, catheter replacement alone was followed by an 87-93% clearance of urinary findings at 8 weeks of follow-up. These results suggest that in patients with funguria low-dose fluconazole induces a more rapid clearance of urinary findings than does catheter replacement alone.