American Board of Internal Medicine (ABIM) Certification Practice Exam

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If treatment becomes necessary for candiduria, what is the drug of choice?

Amphotericin B
Ketoconazole
Clotrimazole
Oral fluconazole

The correct answer is: Oral fluconazole

Fluconazole is the drug of choice for treating candiduria. This recommendation is based on its effectiveness against the Candida species, particularly Candida albicans, which is the most common pathogen causing candiduria. Fluconazole is an oral triazole antifungal that has excellent bioavailability and permeability, allowing it to reach therapeutic levels in the urine. This answer is supported by clinical studies and guidelines that suggest fluconazole’s efficacy in treating urinary tract infections caused by fungi. It can effectively eradicate yeast from the urine, which is particularly important in immunocompromised patients or those with other underlying conditions that may complicate candiduria. Other potential options, such as amphotericin B, while useful in systemic fungal infections, are typically not first-line treatments for candiduria due to their routes of administration and side effect profiles. Ketoconazole and clotrimazole, although antifungals, are less effective or appropriate for treating this specific condition compared to oral fluconazole.