genitourinary disorders
Fungal Urinary Tract Infections
Treatment of Fungal UTIs
Only for symptomatic or high-risk patients Fluconazoleor, for resistant organisms,amphotericin B; sometimesflucytosineis added Fungal colonization of catheters does not require treatment. Asymptomatic candiduria rarely requires therapy. Candiduria should be treated in the following: Symptomatic patients Neutropenic patients Patients with renal allografts Patients who are undergoing urologic manipulation Urinary stents and Foley catheters should be removed (if possible). For symptomatic Cystitis , treatment is with 25 mg/kg orally 4 times a day is added to the regimen if patients have adequate renal function; if not, the dose should be modified based on creatinine clearance (see Antifungal Medications ). Flucytosinemay help eradicate candiduria due to non-albicansspecies ofCandida; however, resistance may emerge rapidly when this compound is used alone. Bladder irrigation withamphotericin Bmay transiently clear candiduria but is no longer indicated for cystitis or pyelonephritis. Even with apparently successful local or systemic antifungal therapy for candiduria, relapse is frequent, and this likelihood is increased by continued use of a urinary catheter. Clinical experience with usingvoriconazoleto treat urinary tract infections (UTIs) is scant. 